Provider Demographics
NPI:1790546372
Name:DOWNSTATE ADULT HEALTH NP, PLLC
Entity Type:Organization
Organization Name:DOWNSTATE ADULT HEALTH NP, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MAGDALENA
Authorized Official - Middle Name:
Authorized Official - Last Name:SZCZEPANSKA
Authorized Official - Suffix:
Authorized Official - Credentials:APN
Authorized Official - Phone:917-816-2955
Mailing Address - Street 1:22 US ROUTE 6
Mailing Address - Street 2:
Mailing Address - City:PORT JERVIS
Mailing Address - State:NY
Mailing Address - Zip Code:12771-3168
Mailing Address - Country:US
Mailing Address - Phone:845-672-6033
Mailing Address - Fax:
Practice Address - Street 1:22 US ROUTE 6
Practice Address - Street 2:
Practice Address - City:PORT JERVIS
Practice Address - State:NY
Practice Address - Zip Code:12771-3168
Practice Address - Country:US
Practice Address - Phone:845-672-6033
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-19
Last Update Date:2024-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center