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NPI Code Detail

MEDICARE: GLORIA KWIZERA PA

MEDICARE:   GLORIA  KWIZERA  PA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician Assistant022186NY

General Provider Information

NPI Number : 1033697040
Entity Type Code : Individual
Provider Name (Legal Business Name) : GLORIA KWIZERA PA
Provider Business Mailing Address
First Line : 449 ROUTE 146 STE 101
Second Line :
City : HALFMOON
State : NY
Zip : 12065-3239
Country : US
Telephone Number : 518-373-3800
Fax Number : 518-373-3808
Provider Business Practice Location Address
First Line : 258 HOOSICK ST
Second Line :
City : TROY
State : NY
Zip : 12180-2444
Country : US
Telephone Number : 518-272-2097
Fax Number : 518-272-6612
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/01/2018
Last Update Date : 01/21/2026

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Directions to “ GLORIA KWIZERA PA” Practice Location

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