Healthcare Provider Details

I. General information

NPI: 1538320189
Provider Name (Legal Business Name): AGNIESZKA KATARZYNA KOWALSKA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2008
Last Update Date: 10/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

STONY BROOK UNIVERSITY HOSPITAL DEPT OF NEUROLOGY HSC T12 020
STONY BROOK NY
11794-8121
US

IV. Provider business mailing address

HSC T12 020 DEPARTMENT OF NEUROLOGY STONY BROOK UNIVERSITY HOSPITAL
STONY BROOK NY
11794-7148
US

V. Phone/Fax

Practice location:
  • Phone: 631-444-2599
  • Fax: 631-444-1474
Mailing address:
  • Phone: 631-444-7878
  • Fax: 631-444-6031

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number248640
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: