1326570847 NPI number — DR. HEATHER MICHELLE KAWALICK MD

Table of content: DR. HEATHER MICHELLE KAWALICK MD (NPI 1326570847)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326570847 NPI number — DR. HEATHER MICHELLE KAWALICK MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KAWALICK
Provider First Name:
HEATHER
Provider Middle Name:
MICHELLE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1326570847
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/29/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1775 YORK AVE APT 12F
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW YORK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10128-6908
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
931-561-0556
Provider Business Mailing Address Fax Number:
917-268-9825

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
124 EAST 84TH ST
Provider Second Line Business Practice Location Address:
SUITE 1B, #3
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10028-4861
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-360-6285
Provider Business Practice Location Address Fax Number:
917-268-9825
Provider Enumeration Date:
04/03/2017

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2084P0800X , with the licence number:  296007-01 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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