Provider Demographics
NPI:1679635031
Name:NIZNIKIEWICZ, STANISLAW - (MD)
Entity Type:Individual
Prefix:DR
First Name:STANISLAW
Middle Name:-
Last Name:NIZNIKIEWICZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:STANISLAW
Other - Middle Name:-
Other - Last Name:NIZNIKIEWICZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:351 HARRISON AVE
Mailing Address - Street 2:351 HARRISON AVE
Mailing Address - City:HARRISON
Mailing Address - State:NY
Mailing Address - Zip Code:10528-2716
Mailing Address - Country:US
Mailing Address - Phone:914-777-1300
Mailing Address - Fax:914-835-0115
Practice Address - Street 1:351 HARRISON AVE
Practice Address - Street 2:351 HARRISON AVE
Practice Address - City:HARRISON
Practice Address - State:NY
Practice Address - Zip Code:10528-2716
Practice Address - Country:US
Practice Address - Phone:914-777-1300
Practice Address - Fax:914-835-0115
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-14
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY170606207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
05E331Medicare ID - Type Unspecified
NYA60162Medicare UPIN
NY05E331Medicare ID - Type Unspecified