Provider Demographics
NPI:1104870682
Name:JEDNACZ, AGNIESKA (OT)
Entity type:Individual
Prefix:MS
First Name:AGNIESKA
Middle Name:
Last Name:JEDNACZ
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3900 SHORE PKWY
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-1130
Mailing Address - Country:US
Mailing Address - Phone:718-646-5700
Mailing Address - Fax:718-646-8802
Practice Address - Street 1:3900 SHORE PKWY
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-1130
Practice Address - Country:US
Practice Address - Phone:718-646-5700
Practice Address - Fax:718-646-8802
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2008-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013757-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYWEX981Medicare ID - Type UnspecifiedOCEAN VIEW MEDICAL P. C.