Provider Demographics
NPI:1497703474
Name:KOWALEC, JOAN KATHRYN (MD)
Entity Type:Individual
Prefix:DR
First Name:JOAN
Middle Name:KATHRYN
Last Name:KOWALEC
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:148 HURON DR
Mailing Address - Street 2:
Mailing Address - City:CHATHAM
Mailing Address - State:NJ
Mailing Address - Zip Code:07928-1238
Mailing Address - Country:US
Mailing Address - Phone:973-926-7472
Mailing Address - Fax:973-923-8063
Practice Address - Street 1:400 OSBORNE TER
Practice Address - Street 2:L-4
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07112-2046
Practice Address - Country:US
Practice Address - Phone:973-926-7472
Practice Address - Fax:973-923-8063
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2013-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA030441207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1691805Medicaid
NJ1691805Medicaid
453672Medicare ID - Type Unspecified