Provider Demographics
NPI:1609967629
Name:IGNATOWICZ, WIESLAW (MD)
Entity type:Individual
Prefix:DR
First Name:WIESLAW
Middle Name:
Last Name:IGNATOWICZ
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 1:62 BAYBERRY LN
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:CT
Mailing Address - Zip Code:06612-1406
Mailing Address - Country:US
Mailing Address - Phone:203-261-1611
Mailing Address - Fax:
Practice Address - Street 1:134 NORMAN AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11222-2940
Practice Address - Country:US
Practice Address - Phone:718-389-3339
Practice Address - Fax:718-383-0642
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY181363-1208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY05D961Medicare ID - Type Unspecified
NYB83849Medicare UPIN