Healthcare Provider Details

I. General information

NPI: 1215543301
Provider Name (Legal Business Name): MALGORZATA KALUZA-MARCINIAK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2020
Last Update Date: 09/23/2020
Certification Date: 09/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

57 SAINT MARKS PL
NEW YORK NY
10003-7902
US

IV. Provider business mailing address

57 SAINT MARKS PL
NEW YORK NY
10003-7902
US

V. Phone/Fax

Practice location:
  • Phone: 212-982-3470
  • Fax: 212-477-0521
Mailing address:
  • Phone: 212-982-3470
  • Fax: 212-477-0521

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberNYCPS-P-3558
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: