Provider Demographics
NPI:1437410388
Name:SYSKA, MARIA BOZENA
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:BOZENA
Last Name:SYSKA
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 1:43 PINE BLVD
Mailing Address - Street 2:
Mailing Address - City:PATCHOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11772-3644
Mailing Address - Country:US
Mailing Address - Phone:631-475-2746
Mailing Address - Fax:
Practice Address - Street 1:43 PINE BLVD
Practice Address - Street 2:
Practice Address - City:PATCHOGUE
Practice Address - State:NY
Practice Address - Zip Code:11772-3644
Practice Address - Country:US
Practice Address - Phone:631-475-2746
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-06
Last Update Date:2012-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2271694174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist