Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 40QA01579300 | NJ |
N | 2251N0400X | Physical Therapist - Neurology | 40QA01579300 | NJ |
NPI | 1578190427 |
---|---|
Provider Name | Meredith Miller Kowalczyk |
First Address | New Providence, NJ 07974-1505 |
Second Address | New Providence, NJ 07974-1505 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/03/2020 |
Last Update Date | 23/03/2020 |