Provider Demographics
NPI:1275840431
Name:KIERZKOWSKI, MAGDALENA LUBACH
Entity Type:Individual
Prefix:
First Name:MAGDALENA
Middle Name:LUBACH
Last Name:KIERZKOWSKI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 MOBILE AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10306-2127
Mailing Address - Country:US
Mailing Address - Phone:212-481-8678
Mailing Address - Fax:212-481-6398
Practice Address - Street 1:303 5TH AVE
Practice Address - Street 2:SUITE 1413
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-6601
Practice Address - Country:US
Practice Address - Phone:212-481-8678
Practice Address - Fax:212-481-6398
Is Sole Proprietor?:No
Enumeration Date:2010-09-09
Last Update Date:2010-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY592570163W00000X, 163WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WP0200XNursing Service ProvidersRegistered NursePediatrics