Basic Information
Provider Information
NPI: 1568790418
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: KULIKOWSKA
FirstName: ANNA
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: RDH
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 150 55TH ST
Address2:  
City: BROOKLYN
State: NY
PostalCode: 112202559
CountryCode: US
TelephoneNumber: 7186308092
FaxNumber: 7186307437
Practice Location
Address1: 5800 3RD AVE
Address2:  
City: BROOKLYN
State: NY
PostalCode: 112203702
CountryCode: US
TelephoneNumber: 7186306180
FaxNumber: 7186307437
Other Information
ProviderEnumerationDate: 12/03/2009
LastUpdateDate: 12/03/2009
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
124Q00000X51025813NYY Dental ProvidersDental Hygienist 

No ID Information.


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