Provider Demographics
NPI:1487649919
Name:GLIWA, AGNIESZKA (MD)
Entity type:Individual
Prefix:
First Name:AGNIESZKA
Middle Name:
Last Name:GLIWA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:134 GREENPOINT AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11222-6577
Mailing Address - Country:US
Mailing Address - Phone:718-349-6160
Mailing Address - Fax:877-618-5851
Practice Address - Street 1:134 GREENPOINT AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11222-6577
Practice Address - Country:US
Practice Address - Phone:718-349-6160
Practice Address - Fax:877-618-5851
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-12
Last Update Date:2019-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY222668207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02440357Medicaid