Healthcare Provider Details

I. General information

NPI: 1699383760
Provider Name (Legal Business Name): BARBARA SOWA RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/15/2020
Last Update Date: 06/02/2022
Certification Date: 06/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1275 YORK AVE
NEW YORK NY
10065-6007
US

IV. Provider business mailing address

590 E MAIN ST
STRATFORD CT
06614-4469
US

V. Phone/Fax

Practice location:
  • Phone: 212-639-2323
  • Fax:
Mailing address:
  • Phone: 203-572-3247
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License NumberRN2319417
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number137404
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: