Healthcare Provider Details

I. General information

NPI: 1679716435
Provider Name (Legal Business Name): RENATA ANNA KOWAL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/09/2009
Last Update Date: 08/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

STONY BROOK ANESTHESIOLOGY UFPC 100 NICOLLS ROAD, HSC, L4, RM 060
STONY BROOK NY
11794-8480
US

IV. Provider business mailing address

100 NICOLLS RD RM 60 PO BOX 1559
STONY BROOK NY
11790-3407
US

V. Phone/Fax

Practice location:
  • Phone: 631-444-2975
  • Fax:
Mailing address:
  • Phone: 631-444-2975
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number253226
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: