Provider Demographics
NPI:1497303689
Name:BRZEZINSKI, JUSTIN KWOK HO
Entity Type:Individual
Prefix:
First Name:JUSTIN
Middle Name:KWOK HO
Last Name:BRZEZINSKI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8313 21ST AVE APT 2F
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11214-2443
Mailing Address - Country:US
Mailing Address - Phone:347-465-5958
Mailing Address - Fax:
Practice Address - Street 1:5401 8TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11220-3229
Practice Address - Country:US
Practice Address - Phone:718-686-8830
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-30
Last Update Date:2019-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY065634-01183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist