Provider Demographics
NPI:1003914706
Name:SLIWOWSKI, STANISLAW (MD)
Entity Type:Individual
Prefix:DR
First Name:STANISLAW
Middle Name:
Last Name:SLIWOWSKI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42 LOCUST AVE STE 5
Mailing Address - Street 2:
Mailing Address - City:WALLINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07057-1300
Mailing Address - Country:US
Mailing Address - Phone:973-473-4033
Mailing Address - Fax:973-473-2988
Practice Address - Street 1:42 LOCUST AVE
Practice Address - Street 2:
Practice Address - City:WALLINGTON
Practice Address - State:NJ
Practice Address - Zip Code:07057-1300
Practice Address - Country:US
Practice Address - Phone:973-473-4033
Practice Address - Fax:973-473-2988
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2016-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA04953900208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ122620701Medicaid
NJ122620701Medicaid
NJSL536503Medicare ID - Type Unspecified