Provider Demographics
NPI:1871532895
Name:SZEWCZYK-SZCZECH, KRYSTYNA (MD)
Entity type:Individual
Prefix:MRS
First Name:KRYSTYNA
Middle Name:
Last Name:SZEWCZYK-SZCZECH
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 1:1033 CLIFTON AVE
Mailing Address - Street 2:SUITE 210
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07013-3517
Mailing Address - Country:US
Mailing Address - Phone:973-472-4400
Mailing Address - Fax:
Practice Address - Street 1:1033 CLIFTON AVE
Practice Address - Street 2:SUITE 210
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07013-3517
Practice Address - Country:US
Practice Address - Phone:973-472-4400
Practice Address - Fax:973-473-6822
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06182900207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6500609Medicaid
NJ6500609Medicaid
NJ648231RPEMedicare ID - Type Unspecified