Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 177699 | NY |
Y | 2080P0214X | Pediatric Pulmonologist | 177699 | NY |
NPI | 1023095205 |
---|---|
Provider Name | Dr. Stephen Julian Wadowski |
First Address | Brooklyn, NY 11234-6721 |
Second Address | Brooklyn, NY 11203-2056 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/12/2005 |
Last Update Date | 02/02/2022 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01636768 | (05) | NY |