Provider Demographics
NPI:1407932650
Name:CIECHANOWSKI, GEORGE J (MD)
Entity Type:Individual
Prefix:MR
First Name:GEORGE
Middle Name:J
Last Name:CIECHANOWSKI
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:PO BOX 8009
Mailing Address - Street 2:
Mailing Address - City:GLEN RIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07028-8009
Mailing Address - Country:US
Mailing Address - Phone:201-963-7000
Mailing Address - Fax:201-963-8331
Practice Address - Street 1:408 SUMMIT AVENUE
Practice Address - Street 2:1ST FLR
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07306
Practice Address - Country:US
Practice Address - Phone:201-963-7000
Practice Address - Fax:201-963-8331
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2011-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA04827300207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0751006Medicaid
C58801Medicare UPIN
NJ0751006Medicaid