Provider Demographics
NPI:1336285311
Name:JOANNA KOWALEWSKI DDS PC
Entity Type:Organization
Organization Name:JOANNA KOWALEWSKI DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:KOWALEWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-389-8889
Mailing Address - Street 1:120 NASSAU AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11222-4024
Mailing Address - Country:US
Mailing Address - Phone:718-389-8889
Mailing Address - Fax:718-389-7502
Practice Address - Street 1:120 NASSAU AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11222-4024
Practice Address - Country:US
Practice Address - Phone:718-389-8889
Practice Address - Fax:718-389-7502
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2007-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0462061223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02717164Medicaid
NY02832882Medicaid