Provider Demographics
NPI:1871555797
Name:WIRKOWSKI, ELZBIETA J (MD)
Entity type:Individual
Prefix:
First Name:ELZBIETA
Middle Name:J
Last Name:WIRKOWSKI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:J
Other - Last Name:WIRKOWSKI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:NEW YORK SPINE & BRAIN SURGERY HSC T12 RM 080
Mailing Address - Street 2:
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11794-8122
Mailing Address - Country:US
Mailing Address - Phone:631-444-1116
Mailing Address - Fax:631-444-1535
Practice Address - Street 1:NEW YORK SPINE & BRAIN SURGERY HSC T12 RM 080
Practice Address - Street 2:
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11794-4235
Practice Address - Country:US
Practice Address - Phone:631-444-1116
Practice Address - Fax:631-444-1535
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2024-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1805122084V0102X, 2084A2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084A2900XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurocritical Care
No2084V0102XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyVascular Neurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY109334OtherUS FAMILY HEALTHPLAN
NY1114277OtherUNITED HEALTHCARE
NY180512-6OtherWORKER'S COMPENSATION
NY1114277OtherUHC
NY5468010OtherAETNA USHC (PPO)
NY180512OtherHIP
NY516JQ2OtherEMPIRE BC/BS
NY1473368004OtherCIGNA
NY180512-B10OtherHEALTHFIRST
NY1473368004OtherCIGNA
NYF66506Medicare UPIN
NY85H491Medicare ID - Type Unspecified
NY730072OtherAETNA USHC(HMO)
NY5088219OtherFIRST HEALTH
NY5468010OtherAETNA USHC (PPO)
NY130014297Medicare ID - Type UnspecifiedRAILROAD
NY85H491OtherBLUE CHOICE
NY1114277OtherUNITED HEALTHCARE
NY180512-6OtherWORKER'S COMPENSATION