Provider Demographics
NPI:1023006095
Name:WITKOWSKI, MARY BETH (MD,FACOG)
Entity Type:Individual
Prefix:DR
First Name:MARY BETH
Middle Name:
Last Name:WITKOWSKI
Suffix:
Gender:F
Credentials:MD,FACOG
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:704 N BEERS ST
Mailing Address - Street 2:
Mailing Address - City:HOLMDEL
Mailing Address - State:NJ
Mailing Address - Zip Code:07733-1519
Mailing Address - Country:US
Mailing Address - Phone:732-739-2500
Mailing Address - Fax:
Practice Address - Street 1:704 N BEERS ST
Practice Address - Street 2:
Practice Address - City:HOLMDEL
Practice Address - State:NJ
Practice Address - Zip Code:07733-1519
Practice Address - Country:US
Practice Address - Phone:732-739-2500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-12
Last Update Date:2007-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA63154207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1K3601OtherHEALTHNET
NJ0644121000OtherAMERIHEALTH
NJ7393709Medicaid
NJP1278196OtherOXFORD
NJP1278196OtherOXFORD
NJ7393709Medicaid