Healthcare Provider Details

I. General information

NPI: 1659303295
Provider Name (Legal Business Name): WENDY JO KOWALSKI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 03/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 S CEDAR CREST BLVD
ALLENTOWN PA
18103-6202
US

IV. Provider business mailing address

PO BOX 783311
PHILADELPHIA PA
19178-3311
US

V. Phone/Fax

Practice location:
  • Phone: 610-402-7632
  • Fax:
Mailing address:
  • Phone: 484-884-4500
  • Fax: 484-884-0669

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License NumberMD419863
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: