Healthcare Provider Details

I. General information

NPI: 1669717286
Provider Name (Legal Business Name): MARK KOWALSKI BC-HIS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/07/2012
Last Update Date: 08/30/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2350 FREEDOM WAY STE 109
YORK PA
17402-8200
US

IV. Provider business mailing address

115 ROUTE 46 STE G51
MOUNTAIN LAKES NJ
07046-1668
US

V. Phone/Fax

Practice location:
  • Phone: 717-741-4327
  • Fax: 717-741-4333
Mailing address:
  • Phone: 973-588-7266
  • Fax: 973-588-7268

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberF0350600
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: