Provider Demographics
NPI:1790811313
Name:NIEBRZYDOWSKA, KATARZYNA EWA (PT)
Entity Type:Individual
Prefix:
First Name:KATARZYNA
Middle Name:EWA
Last Name:NIEBRZYDOWSKA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:258 HETT AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10306-5672
Mailing Address - Country:US
Mailing Address - Phone:718-980-4479
Mailing Address - Fax:
Practice Address - Street 1:258 HETT AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10306-5672
Practice Address - Country:US
Practice Address - Phone:718-980-4479
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY026089225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ15P51Medicare ID - Type Unspecified