Provider Demographics
NPI:1558384198
Name:NOWAKOWSKI, JOHN (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:NOWAKOWSKI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 BRADHURST AVE
Mailing Address - Street 2:
Mailing Address - City:HAWTHORNE
Mailing Address - State:NY
Mailing Address - Zip Code:10532-2140
Mailing Address - Country:US
Mailing Address - Phone:914-493-8865
Mailing Address - Fax:914-594-4434
Practice Address - Street 1:19 BRADHURST AVE
Practice Address - Street 2:
Practice Address - City:HAWTHORNE
Practice Address - State:NY
Practice Address - Zip Code:10532-2140
Practice Address - Country:US
Practice Address - Phone:914-493-8865
Practice Address - Fax:914-594-4434
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2017-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY169963207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY4301583OtherAETNA PPO
NY62F191OtherEMPIRE BCBS
NYP00290798OtherRAILROAD MEDICARE
NY00000017466OtherGHI HMO
NY169963OtherHIP
NY169963OtherCONNECTICARE
NYWS463OtherOXFORD
NY2500455OtherGHI PPO
NY5C6269OtherHEALTHNET
NY01209769Medicaid
NY925641OtherMVP
NY0031055OtherAETNA HMO
NY5C6269OtherHEALTHNET