Provider Demographics
NPI:1417548017
Name:FRYZLEWICZ (LEBIODA), KINGA
Entity Type:Individual
Prefix:
First Name:KINGA
Middle Name:
Last Name:FRYZLEWICZ (LEBIODA)
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KINGA
Other - Middle Name:
Other - Last Name:LEBIODA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:APN
Mailing Address - Street 1:3600 ROUTE 66
Mailing Address - Street 2:FL 3
Mailing Address - City:NEPTUNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07753-2645
Mailing Address - Country:US
Mailing Address - Phone:732-807-0877
Mailing Address - Fax:201-751-1680
Practice Address - Street 1:30 PROSPECT AVE
Practice Address - Street 2:
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-1915
Practice Address - Country:US
Practice Address - Phone:551-996-2000
Practice Address - Fax:551-996-4915
Is Sole Proprietor?:No
Enumeration Date:2021-01-27
Last Update Date:2021-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ01106500363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner