Provider Demographics
NPI:1285165878
Name:BRAKONIECKI, KATRINA ALICIA
Entity type:Individual
Prefix:
First Name:KATRINA
Middle Name:ALICIA
Last Name:BRAKONIECKI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 E 61ST ST APT 4B
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10065-9004
Mailing Address - Country:US
Mailing Address - Phone:860-918-3685
Mailing Address - Fax:
Practice Address - Street 1:130 E 61ST ST APT 4B
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10065-9004
Practice Address - Country:US
Practice Address - Phone:860-918-3685
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-24
Last Update Date:2017-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program