1497732598 NPI number — DR. JESSE JOSEPH STAWICKI D.O.

Table of content: JORDAN GREEN CRNA (NPI 1437034451)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497732598 NPI number — DR. JESSE JOSEPH STAWICKI D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STAWICKI
Provider First Name:
JESSE
Provider Middle Name:
JOSEPH
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.O.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1497732598
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/13/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9 HAMTON CT E
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROBBINSVILLE
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08691-3640
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
609-581-5586
Provider Business Mailing Address Fax Number:
609-581-5779

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1235 WHITEHORSE MERCERVILLE RD
Provider Second Line Business Practice Location Address:
SUITE 316 BLDG. C
Provider Business Practice Location Address City Name:
MERCERVILLE
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08619-3810
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
609-581-5586
Provider Business Practice Location Address Fax Number:
609-581-5779
Provider Enumeration Date:
12/29/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  MB46599 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1K3956 . This is a "PHS/HEALTHNET" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 2261107 . This is a "AETNA" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 223709512 . This is a "GREAT WEST" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 5404703 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: MEP111 . This is a "OXFORD" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 223709512 . This is a "HORIZON" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 4208912 . This is a "TRADITIONAL AETNA" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 047593100 . This is a "AMERIHEALTH/KEYSTONE/PERS" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 110207564 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 645148 . This is a "AMERIHEALTH ADMIN." identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 0927766 . This is a "CIGNA" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 2158854000 . This is a "AMERIHEALTH 65" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 987766 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




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