Provider Demographics
NPI:1336725563
Name:KWIATKOWSKI, ADRIAN (MS)
Entity Type:Individual
Prefix:
First Name:ADRIAN
Middle Name:
Last Name:KWIATKOWSKI
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2212 36TH ST
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11105-2211
Mailing Address - Country:US
Mailing Address - Phone:646-300-5025
Mailing Address - Fax:
Practice Address - Street 1:600 3RD AVE FL 2
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-1919
Practice Address - Country:US
Practice Address - Phone:646-798-4022
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-18
Last Update Date:2023-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP109047106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist