MEDICARE: LUCYNA KWIECIEN RN

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	390200000X	Student in an Organized Health Care Education/Training Program	571494-1	NY

General Provider Information

NPI Number	:	1578917951
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LUCYNA KWIECIEN RN

Provider Business Mailing Address
First Line	:	2399 BOYNTON PLACE 1A
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11223
Country	:	US
Telephone Number	:	437-515-1050
Fax Number	:

Provider Business Practice Location Address
First Line	:	2399 BOYNTON PLACE
Second Line	:	1A
City	:	NEW YORK
State	:	NY
Zip	:	11223
Country	:	US
Telephone Number	:	347-515-1050
Fax Number	:

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

Provider Enumeration Date	:	04/21/2016
Last Update Date	:	04/21/2016

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