Provider Demographics
NPI:1841633294
Name:KONIARZ, WIOLETTA BEATA (NP)
Entity type:Individual
Prefix:
First Name:WIOLETTA
Middle Name:BEATA
Last Name:KONIARZ
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:NA
Other - Middle Name:NA
Other - Last Name:NA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NP
Mailing Address - Street 1:5241 72ND ST
Mailing Address - Street 2:
Mailing Address - City:MASPETH
Mailing Address - State:NY
Mailing Address - Zip Code:11378-1435
Mailing Address - Country:US
Mailing Address - Phone:347-268-3918
Mailing Address - Fax:
Practice Address - Street 1:5241 72ND ST
Practice Address - Street 2:
Practice Address - City:MASPETH
Practice Address - State:NY
Practice Address - Zip Code:11378-1435
Practice Address - Country:US
Practice Address - Phone:347-268-3918
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-15
Last Update Date:2016-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY366358363LA2200X
NY340887363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health