Provider Demographics
NPI:1063436798
Name:KOWACZ, TOMASZ WOJCIECH (MD)
Entity type:Individual
Prefix:DR
First Name:TOMASZ
Middle Name:WOJCIECH
Last Name:KOWACZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9805 67TH AVE APT 9C
Mailing Address - Street 2:
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-4928
Mailing Address - Country:US
Mailing Address - Phone:718-897-5061
Mailing Address - Fax:
Practice Address - Street 1:606 WINTHROP ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11203-1709
Practice Address - Country:US
Practice Address - Phone:718-245-2313
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2008-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2145082084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA400000570Medicare PIN