Provider Demographics
NPI:1346628567
Name:GOLABEK, AGNIESZKA (APN)
Entity Type:Individual
Prefix:
First Name:AGNIESZKA
Middle Name:
Last Name:GOLABEK
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:714 10TH ST
Mailing Address - Street 2:
Mailing Address - City:SECAUCUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07094-2921
Mailing Address - Country:US
Mailing Address - Phone:201-368-1717
Mailing Address - Fax:201-368-9618
Practice Address - Street 1:714 10TH ST
Practice Address - Street 2:
Practice Address - City:SECAUCUS
Practice Address - State:NJ
Practice Address - Zip Code:07094-2921
Practice Address - Country:US
Practice Address - Phone:201-368-1717
Practice Address - Fax:201-368-9618
Is Sole Proprietor?:No
Enumeration Date:2015-05-07
Last Update Date:2016-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00563700363LA2200X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology