Provider Demographics
NPI:1427099829
Name:KORTOWSKA, MALGORZATA MODRZEJEWSKA (MD)
Entity type:Individual
Prefix:DR
First Name:MALGORZATA
Middle Name:MODRZEJEWSKA
Last Name:KORTOWSKA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:266 LAKEVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07011-4026
Mailing Address - Country:US
Mailing Address - Phone:973-340-6225
Mailing Address - Fax:973-340-0665
Practice Address - Street 1:266 LAKEVIEW AVE
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07011-4026
Practice Address - Country:US
Practice Address - Phone:973-340-6225
Practice Address - Fax:973-340-0665
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2012-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA0659092080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine