Healthcare Provider Details

I. General information

NPI: 1316325236
Provider Name (Legal Business Name): LOURDES KOWALSKI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2015
Last Update Date: 05/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15032 114TH PL
SOUTH OZONE PARK NY
11420-3928
US

IV. Provider business mailing address

15032 114TH PL
SOUTH OZONE PARK NY
11420-3928
US

V. Phone/Fax

Practice location:
  • Phone: 917-254-5422
  • Fax:
Mailing address:
  • Phone: 917-254-5422
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: