Provider Demographics
NPI:1497283121
Name:STEC, JADWIGA KATARZYNA
Entity Type:Individual
Prefix:DR
First Name:JADWIGA
Middle Name:KATARZYNA
Last Name:STEC
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 1:936 METROPOLITAN AVE APT 2B
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11211-2657
Mailing Address - Country:US
Mailing Address - Phone:718-809-8156
Mailing Address - Fax:
Practice Address - Street 1:179 JAMAICA AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11207-2049
Practice Address - Country:US
Practice Address - Phone:929-267-5354
Practice Address - Fax:929-267-5340
Is Sole Proprietor?:No
Enumeration Date:2017-05-25
Last Update Date:2018-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NY59872-11223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program