Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | 206320 | NY |
NPI | 1174511760 |
---|---|
Provider Name | Monika Isabela Woroniecka |
First Address | Stony Brook, NY 11790-0989 |
Second Address | Stony Brook, NY 11794-0001 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/10/2005 |
Last Update Date | 04/08/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01711811 | (05) | NY |
H51947 | (02) | NY |