Provider Demographics
NPI:1336310788
Name:HUZAR, DIANA EWA (DO)
Entity Type:Individual
Prefix:DR
First Name:DIANA
Middle Name:EWA
Last Name:HUZAR
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:402 LIPPINCOTT DR
Mailing Address - Street 2:
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-4112
Mailing Address - Country:US
Mailing Address - Phone:856-782-3300
Mailing Address - Fax:856-504-8029
Practice Address - Street 1:249 STATE RT 94
Practice Address - Street 2:
Practice Address - City:VERNON
Practice Address - State:NJ
Practice Address - Zip Code:07462-0739
Practice Address - Country:US
Practice Address - Phone:973-827-4550
Practice Address - Fax:973-827-5845
Is Sole Proprietor?:No
Enumeration Date:2008-03-13
Last Update Date:2010-03-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MB08556600208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
077356 SK3Medicare PIN