Provider Demographics
NPI:1689828337
Name:NOWAKIWSKYJ, VERA NADIA (MD)
Entity Type:Individual
Prefix:DR
First Name:VERA
Middle Name:NADIA
Last Name:NOWAKIWSKYJ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1925 KENNEDY BLVD
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07305-2117
Mailing Address - Country:US
Mailing Address - Phone:201-344-8474
Mailing Address - Fax:
Practice Address - Street 1:15 SIEGEL DR
Practice Address - Street 2:
Practice Address - City:ELLENVILLE
Practice Address - State:NY
Practice Address - Zip Code:12428-2312
Practice Address - Country:US
Practice Address - Phone:201-344-8474
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-07
Last Update Date:2008-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY160942207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease