MEDICARE: DR. DOROTA B KOWALSKA MD

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
1	207V00000X	Obstetrics & Gynecology Physician	268634	NY

General Provider Information

NPI Number	:	1295960243
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DOROTA B KOWALSKA MD

Provider Business Mailing Address
First Line	:	4875 SUNRISE HWY
Second Line	:	SUITE 200
City	:	BOHEMIA
State	:	NY
Zip	:	11716-4630
Country	:	US
Telephone Number	:	631-444-4868
Fax Number	:

Provider Business Practice Location Address
First Line	:	4875 SUNRISE HWY
Second Line	:	SUITE 200
City	:	BOHEMIA
State	:	NY
Zip	:	11716-4630
Country	:	US
Telephone Number	:	631-444-4686
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/20/2009
Last Update Date	:	04/21/2022

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