Healthcare Provider Details

I. General information

NPI: 1952045809
Provider Name (Legal Business Name): MICHELLE A KOWALSKI M.S., R.D, CDN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/26/2022
Last Update Date: 04/26/2022
Certification Date: 04/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

669 PORT WASHINGTON BLVD
PORT WASHINGTON NY
11050
US

IV. Provider business mailing address

664 PORT WASHINGTON BLVD
PORT WASHINGTON NY
11050
US

V. Phone/Fax

Practice location:
  • Phone: 516-767-3636
  • Fax: 516-767-9699
Mailing address:
  • Phone: 516-767-3636
  • Fax: 516-767-9699

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number003950-01
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code133VN1006X
TaxonomyMetabolic Nutrition Registered Dietitian
License Number003950-01
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code133VN1201X
TaxonomyObesity and Weight Management Nutrition Registered Dietitian
License Number003950-01
License Number StateNY
# 4
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number003950-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: