Healthcare Provider Details

I. General information

NPI: 1033514013
Provider Name (Legal Business Name): MARIA ANNA OBRYCKA NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARIA ANNA GODLEWSKI RN

II. Dates (important events)

Enumeration Date: 11/03/2014
Last Update Date: 01/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 GUSTAVE L. LEVY PL
NEW YORK NY
10029
US

IV. Provider business mailing address

943 LORIMER ST
BROOKLYN NY
11222-3103
US

V. Phone/Fax

Practice location:
  • Phone: 212-241-7344
  • Fax:
Mailing address:
  • Phone: 917-331-4172
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number307020
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: