Active NPI
Agnieszka Kowalczyk
- Pediatric Sports Medicine Physician
- Boston, MA
National Provider Identifier
1205243078
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Sports Medicine Physician
- License
- 270843
- Practice address
- 319 Longwood Ave
Boston, MA 02115-5728 - Phone
- (617) 355-3501
- NPI assigned
- Jul 14, 2014
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 125065742 | IL | |
| Pediatric Sports Medicine Physician | 2080S0010X | 270843 | MA | Primary |
Addresses
Primary practice location
319 Longwood Ave
Boston, MA 02115-5728
Mailing address
319 Longwood Ave
Boston, MA 02115-5728
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 270843 | MA | MD | Pediatric Sports Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1405296000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1502668800000",
"number": "1205243078",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "319 LONGWOOD AVE",
"city": "BOSTON",
"state": "MA",
"postal_code": "021155728"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "319 LONGWOOD AVE",
"city": "BOSTON",
"state": "MA",
"postal_code": "021155728",
"telephone_number": "617-355-3501"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KOWALCZYK",
"first_name": "AGNIESZKA",
"name_prefix": "Dr.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2014-07-14",
"last_updated": "2017-08-14",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "IL",
"license": "125065742",
"primary": false
},
{
"code": "2080S0010X",
"taxonomy_group": "",
"desc": "Pediatrics, Sports Medicine",
"state": "MA",
"license": "270843",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Boston, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 14, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.