1508474776 NPI number — DR. MARIA BEATA BLASZCZYK MBCHB (MD EQUIVALENT

Table of content: SARAH JENKINS (NPI 1750749081)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508474776 NPI number — DR. MARIA BEATA BLASZCZYK MBCHB (MD EQUIVALENT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BLASZCZYK
Provider First Name:
MARIA
Provider Middle Name:
BEATA
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MBCHB (MD EQUIVALENT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BLASZCZYK
Provider Other First Name:
MARYJKA
Provider Other Middle Name:
BEATA
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1508474776
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/14/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
461 CHERRY VALLEY RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PRINCETON
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08540-7916
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
512-487-9295
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
125 PATERSON ST # 212
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW BRUNSWICK
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08901-1962
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
512-487-9295
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/14/2020

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: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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