Healthcare Provider Details

I. General information

NPI: 1740084920
Provider Name (Legal Business Name): ARTUR WYSOCZANSKI
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2025
Last Update Date: 04/04/2025
Certification Date: 04/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 HAVEN AVE APT 12C
NEW YORK NY
10032-2624
US

IV. Provider business mailing address

100 HAVEN AVE APT 12C
NEW YORK NY
10032-2624
US

V. Phone/Fax

Practice location:
  • Phone: 413-386-9665
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: