Healthcare Provider Details

I. General information

NPI: 1518284256
Provider Name (Legal Business Name): MAGDALENA EWA SZKLARSKA-IMIOLEK M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2010
Last Update Date: 04/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

490 E RIDGE RD
ROCHESTER NY
14621
US

IV. Provider business mailing address

100 KINGS HWY S
ROCHESTER NY
14617-5504
US

V. Phone/Fax

Practice location:
  • Phone: 585-922-2500
  • Fax:
Mailing address:
  • Phone: 585-922-0553
  • Fax: 585-922-2646

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number273149
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: