Provider Demographics
NPI:1326045295
Name:KEDZIERSKA, KSYMENA (MD)
Entity Type:Individual
Prefix:
First Name:KSYMENA
Middle Name:
Last Name:KEDZIERSKA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 DOCTORS PARK
Mailing Address - Street 2:SUITE C
Mailing Address - City:HACKETTSTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07840-1716
Mailing Address - Country:US
Mailing Address - Phone:908-852-8096
Mailing Address - Fax:908-852-5012
Practice Address - Street 1:4C DOCTORS PARK
Practice Address - Street 2:
Practice Address - City:HACKETTSTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07840-1716
Practice Address - Country:US
Practice Address - Phone:908-852-8096
Practice Address - Fax:908-852-5012
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2019-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07788100208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0060691Medicaid
NJ089450Medicare ID - Type Unspecified
NJ0060691Medicaid