Provider Demographics
NPI:1154511509
Name:MEDICINE & NEPHROLOGY ASSOCIATES OF NORTHWEST JERSEY, P.C.
Entity Type:Organization
Organization Name:MEDICINE & NEPHROLOGY ASSOCIATES OF NORTHWEST JERSEY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KRYSTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:SWANNICK-KONOPCZYNSKI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:908-812-0815
Mailing Address - Street 1:PO BOX 764
Mailing Address - Street 2:
Mailing Address - City:HACKETTSTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07840-0764
Mailing Address - Country:US
Mailing Address - Phone:908-684-4244
Mailing Address - Fax:908-684-4344
Practice Address - Street 1:184 MOUNTAIN AVE
Practice Address - Street 2:
Practice Address - City:HACKETTSTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07840-2412
Practice Address - Country:US
Practice Address - Phone:908-684-4244
Practice Address - Fax:908-684-4344
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-31
Last Update Date:2007-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA07293000261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty