Healthcare Provider Details

I. General information

NPI: 1588993026
Provider Name (Legal Business Name): EWA M SIUZDAK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2009
Last Update Date: 01/25/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

459 BROADWAY
NEW YORK NY
10013-3001
US

IV. Provider business mailing address

459 BROADWAY
NEW YORK NY
10013-3001
US

V. Phone/Fax

Practice location:
  • Phone: 212-219-2658
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number053411-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: