Healthcare Provider Details

I. General information

NPI: 1174952972
Provider Name (Legal Business Name): IWONA MONIKA WOJCIECHOWSKA-ROMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/02/2013
Last Update Date: 11/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

773 9TH AVE
NEW YORK NY
10019-6336
US

IV. Provider business mailing address

773 9TH AVE
NEW YORK NY
10019-6336
US

V. Phone/Fax

Practice location:
  • Phone: 212-586-1550
  • Fax:
Mailing address:
  • Phone: 212-586-1550
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number641243-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: