Provider Demographics
NPI:1760031447
Name:PAS, AGNIESZKA KATARZYNA
Entity Type:Individual
Prefix:
First Name:AGNIESZKA
Middle Name:KATARZYNA
Last Name:PAS
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 1:12 PIERRE DR
Mailing Address - Street 2:
Mailing Address - City:COMMACK
Mailing Address - State:NY
Mailing Address - Zip Code:11725-4410
Mailing Address - Country:US
Mailing Address - Phone:347-254-2755
Mailing Address - Fax:
Practice Address - Street 1:12 PIERRE DR
Practice Address - Street 2:
Practice Address - City:COMMACK
Practice Address - State:NY
Practice Address - Zip Code:11725-4410
Practice Address - Country:US
Practice Address - Phone:347-254-2755
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-05
Last Update Date:2019-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY639685-01163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse