Provider Demographics
NPI:1720004997
Name:STAWIARSKI, IWONA M
Entity Type:Individual
Prefix:
First Name:IWONA
Middle Name:M
Last Name:STAWIARSKI
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 1:145 NASSAU AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11222-4004
Mailing Address - Country:US
Mailing Address - Phone:718-389-6575
Mailing Address - Fax:
Practice Address - Street 1:145 NASSAU AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11222-4004
Practice Address - Country:US
Practice Address - Phone:718-389-6575
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY212145207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
3C0586OtherHEALTH NET
P2372162OtherOXFORD
NY077AG1OtherEMPIRE BC/BS
33956POtherHIP
NYG89224Medicare UPIN
33956POtherHIP