Provider Demographics
NPI:1831673177
Name:KACPERSKI, EWA
Entity Type:Individual
Prefix:
First Name:EWA
Middle Name:
Last Name:KACPERSKI
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 1:8377 WOODHAVEN BLVD APT 3D
Mailing Address - Street 2:
Mailing Address - City:WOODHAVEN
Mailing Address - State:NY
Mailing Address - Zip Code:11421-1520
Mailing Address - Country:US
Mailing Address - Phone:718-310-7337
Mailing Address - Fax:
Practice Address - Street 1:8377 WOODHAVEN BLVD APT 3D
Practice Address - Street 2:
Practice Address - City:WOODHAVEN
Practice Address - State:NY
Practice Address - Zip Code:11421-1520
Practice Address - Country:US
Practice Address - Phone:718-310-7337
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-22
Last Update Date:2018-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant