Provider Demographics
NPI:1912936097
Name:KIELCZEWSKI, DOROTA (RPH)
Entity Type:Individual
Prefix:MRS
First Name:DOROTA
Middle Name:
Last Name:KIELCZEWSKI
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:MS
Other - First Name:DOROTA
Other - Middle Name:
Other - Last Name:MODZELEWSKA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RPH
Mailing Address - Street 1:8510 13TH AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11228-3338
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:423 E 23RD ST
Practice Address - Street 2:PHARMACY/119
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-5011
Practice Address - Country:US
Practice Address - Phone:212-686-7500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI02719200183500000X
NY047034183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist