1720050776 NPI number — PHILIP A KORZENIOWSKI M.D.

Table of content: PHILIP A KORZENIOWSKI M.D. (NPI 1720050776)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720050776 NPI number — PHILIP A KORZENIOWSKI M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KORZENIOWSKI
Provider First Name:
PHILIP
Provider Middle Name:
A
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1720050776
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/14/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 22581
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW YORK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10087-2581
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-482-4795
Provider Business Mailing Address Fax Number:
856-528-3117

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
599 SHORE RD
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
SOMERS POINT
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08244-2400
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
609-926-8353
Provider Business Practice Location Address Fax Number:
609-926-4579
Provider Enumeration Date:
02/03/2006

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: 207V00000X , with the licence number:  MA059875 , 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)





Copyright © 2007-2025 www.npivalidator.com