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General NPI Number Information
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NPI Number | 1821483405
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Entity Type | Individual
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Provider Name | JANIPER KWAK M.D.
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Gender | Female
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Dates
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Enumeration Date | 04/01/2015
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Last Update Date | 03/01/2024
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Provider Practice Location Address
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Address Line | 1979 MARCUS AVE
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City | NEW HYDE PARK
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State | NY
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Zip | 11042-1076
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Country | US
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Telephone | 516-754-6740
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Fax |
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Provider Business Mailing Address
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Address Line | 9 FITCH AVE
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City | DARIEN
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State | CT
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Zip | 06820-5334
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Country | US
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Telephone | 917-903-3434
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2083P0901X
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Taxonomy Name | Public Health & General Preventive Medicine Physician
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License Number | 300644
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License Number State | NY
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