Provider Demographics
NPI:1912355215
Name:KANIEWSKI, JUSTYNA
Entity Type:Individual
Prefix:
First Name:JUSTYNA
Middle Name:
Last Name:KANIEWSKI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 FARMINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:CT
Mailing Address - Zip Code:06010-4701
Mailing Address - Country:US
Mailing Address - Phone:860-585-1156
Mailing Address - Fax:860-585-1160
Practice Address - Street 1:1400 FARMINGTON AVE
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:CT
Practice Address - Zip Code:06010-4701
Practice Address - Country:US
Practice Address - Phone:860-585-1156
Practice Address - Fax:860-585-1160
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-26
Last Update Date:2016-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician