Provider Demographics
NPI:1881666097
Name:WATKOWSKA, JUSTYNA (MD, FACC)
Entity Type:Individual
Prefix:
First Name:JUSTYNA
Middle Name:
Last Name:WATKOWSKA
Suffix:
Gender:F
Credentials:MD, FACC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 LILY POND LN
Mailing Address - Street 2:
Mailing Address - City:KATONAH
Mailing Address - State:NY
Mailing Address - Zip Code:10536-1803
Mailing Address - Country:US
Mailing Address - Phone:914-301-5277
Mailing Address - Fax:
Practice Address - Street 1:1787 MADISON AVE
Practice Address - Street 2:SUITE # 50 C
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10035-4518
Practice Address - Country:US
Practice Address - Phone:212-348-9400
Practice Address - Fax:212-348-9405
Is Sole Proprietor?:No
Enumeration Date:2006-02-02
Last Update Date:2021-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT43817207RC0000X
NY219286207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02377535Medicaid
NY02377535Medicaid
NYA300026668Medicare PIN