Individual
IWONA K MIENKO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
6412 FRESH POND RD, RIDGEWOOD, NY 11385-3331
(718) 497-1565
(718) 497-1567
Mailing address
6412 FRESH POND RD, RIDGEWOOD, NY 11385-3331
(718) 497-1565
(718) 497-1567
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
217951
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02105622
—
NY
Enumeration date
02/27/2012
Last updated
02/27/2012
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