Provider Demographics
NPI:1184905192
Name:MACKOWIAK, MEGHAN COLLEEN (CPNP)
Entity type:Individual
Prefix:
First Name:MEGHAN
Middle Name:COLLEEN
Last Name:MACKOWIAK
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7337 AUSTIN ST
Mailing Address - Street 2:APT 1C
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-6258
Mailing Address - Country:US
Mailing Address - Phone:609-230-4274
Mailing Address - Fax:
Practice Address - Street 1:1143 47TH AVE
Practice Address - Street 2:
Practice Address - City:LONG ISLAND CITY
Practice Address - State:NY
Practice Address - Zip Code:11101-5465
Practice Address - Country:US
Practice Address - Phone:718-551-3515
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-02
Last Update Date:2014-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY38 382221363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03713715Medicaid