Provider Demographics
NPI:1578045282
Name:BIALKWSKI, BROOKE ANN
Entity Type:Individual
Prefix:MS
First Name:BROOKE
Middle Name:ANN
Last Name:BIALKWSKI
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 1:115 WINDWATCH DR
Mailing Address - Street 2:
Mailing Address - City:HAUPPAUGE
Mailing Address - State:NY
Mailing Address - Zip Code:11788-3350
Mailing Address - Country:US
Mailing Address - Phone:631-265-9289
Mailing Address - Fax:
Practice Address - Street 1:115 WINDWATCH DR
Practice Address - Street 2:
Practice Address - City:HAUPPAUGE
Practice Address - State:NY
Practice Address - Zip Code:11788-3350
Practice Address - Country:US
Practice Address - Phone:631-265-9289
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-30
Last Update Date:2018-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY330221-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse