Provider Demographics
NPI:1205108560
Name:KOWALSKI, ROBIN MARY (COTA)
Entity type:Individual
Prefix:
First Name:ROBIN
Middle Name:MARY
Last Name:KOWALSKI
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1912 GREENPOINT AVE
Mailing Address - Street 2:
Mailing Address - City:SCHENECTADY
Mailing Address - State:NY
Mailing Address - Zip Code:12303-4027
Mailing Address - Country:US
Mailing Address - Phone:518-355-2748
Mailing Address - Fax:
Practice Address - Street 1:1912 GREENPOINT AVE
Practice Address - Street 2:
Practice Address - City:SCHENECTADY
Practice Address - State:NY
Practice Address - Zip Code:12303-4027
Practice Address - Country:US
Practice Address - Phone:518-355-2748
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-02
Last Update Date:2012-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003971-1172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker