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NPI Code Detail

MEDICARE: MRS. LISA MARIA GOSTKOWSKI

MEDICARE: MRS. LISA MARIA GOSTKOWSKI
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
1174400000XSpecialist010880NY

General Provider Information

NPI Number : 1437250420
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. LISA MARIA GOSTKOWSKI
Provider Business Mailing Address
First Line : 1855 UNION BLVD
Second Line : SUITE C
City : BAY SHORE
State : NY
Zip : 11706-7949
Country : US
Telephone Number : 631-968-8511
Fax Number :
Provider Business Practice Location Address
First Line : 1855 UNION BLVD
Second Line : SUITE C
City : BAY SHORE
State : NY
Zip : 11706-7949
Country : US
Telephone Number : 631-968-8511
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/25/2006
Last Update Date : 07/08/2007

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Directions to “ MRS. LISA MARIA GOSTKOWSKI ” Practice Location

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