Provider Demographics
NPI:1871892000
Name:MITROWSKI, JUSTINE A
Entity type:Individual
Prefix:MRS
First Name:JUSTINE
Middle Name:A
Last Name:MITROWSKI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6997 CAMPBELL BLVD
Mailing Address - Street 2:
Mailing Address - City:NORTH TONAWANDA
Mailing Address - State:NY
Mailing Address - Zip Code:14120-9605
Mailing Address - Country:US
Mailing Address - Phone:716-625-7106
Mailing Address - Fax:716-625-7107
Practice Address - Street 1:6997 CAMPBELL BLVD
Practice Address - Street 2:
Practice Address - City:NORTH TONAWANDA
Practice Address - State:NY
Practice Address - Zip Code:14120-9605
Practice Address - Country:US
Practice Address - Phone:716-625-7106
Practice Address - Fax:716-625-7107
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-28
Last Update Date:2011-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016181-3174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist