Provider Demographics
NPI:1417254970
Name:STASIAK CARIC, MALGORZATA (NP)
Entity Type:Individual
Prefix:
First Name:MALGORZATA
Middle Name:
Last Name:STASIAK CARIC
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:MALGORZATA
Other - Middle Name:
Other - Last Name:STASIAK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:1220 PINE TREE RD
Mailing Address - Street 2:
Mailing Address - City:CUTCHOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11935-1555
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1220 PINE TREE RD
Practice Address - Street 2:
Practice Address - City:CUTCHOGUE
Practice Address - State:NY
Practice Address - Zip Code:11935-1555
Practice Address - Country:US
Practice Address - Phone:631-727-2827
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-18
Last Update Date:2011-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF3024041363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health