Healthcare Provider Details

I. General information

NPI: 1982243259
Provider Name (Legal Business Name): LOWRIE P KENIGSBERG PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/03/2020
Last Update Date: 11/14/2023
Certification Date: 11/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1305 YORK AVE
NEW YORK NY
10021-5663
US

IV. Provider business mailing address

225 WILLIAMSON ST
ELIZABETH NJ
07202-3625
US

V. Phone/Fax

Practice location:
  • Phone: 646-962-2020
  • Fax:
Mailing address:
  • Phone: 908-994-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number25MP00677800
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number025018-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: