| Doctor Name: | MR. STANLEY W. MODRZAKOWSKI |
| NPI Number: | 1033225396 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | RN |
| License Number: | 136653 |
| Business Practice Address: | 421 N Main St Leeds, MA - 010539764 |
| Business Phone Number: | 4135844040 |
| Business Fax Number: | 4135823178 |
| Mailing Address: | 421 N Main St, LEEDS |
| State: | MA |
| Postal Code: | 010539764 |
| Phone Number: | 4135844040 |
| Fax Number: | 4135823178 |
| NPI Enumeration Date: | 08/21/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 163WC1500X |
| License Number: | 136653 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MA |
| Taxonomy Type: | Nursing Service Providers |
| Taxonomy Classification: | Registered Nurse |
| Taxonomy Specialization: | Community Health |
| Taxonomy Definition: | |