Provider Demographics
NPI:1255560892
Name:MLYNARCZYK, MONIKA EWA (PT)
Entity type:Individual
Prefix:
First Name:MONIKA
Middle Name:EWA
Last Name:MLYNARCZYK
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 1:6120 GRAND CENTRAL PKWY APT A707
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-1276
Mailing Address - Country:US
Mailing Address - Phone:347-738-4840
Mailing Address - Fax:
Practice Address - Street 1:6120 GRAND CENTRAL PKWY APT A707
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-1276
Practice Address - Country:US
Practice Address - Phone:347-738-4840
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-03
Last Update Date:2009-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY21690225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist