Provider Demographics
NPI:1235501982
Name:SZCZEPANEK, PATRYCJA (PA)
Entity Type:Individual
Prefix:
First Name:PATRYCJA
Middle Name:
Last Name:SZCZEPANEK
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 FRANKLIN AVE
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11530-1613
Mailing Address - Country:US
Mailing Address - Phone:516-877-2626
Mailing Address - Fax:516-877-0945
Practice Address - Street 1:1401 FRANKLIN AVE
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:NY
Practice Address - Zip Code:11530-1613
Practice Address - Country:US
Practice Address - Phone:516-877-2626
Practice Address - Fax:516-877-0945
Is Sole Proprietor?:No
Enumeration Date:2015-10-21
Last Update Date:2018-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019260363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant