Provider Demographics
NPI:1487659124
Name:SZANIAWSKI, STANLEY J (DPM)
Entity Type:Individual
Prefix:DR
First Name:STANLEY
Middle Name:J
Last Name:SZANIAWSKI
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 DRUM POINT RD
Mailing Address - Street 2:
Mailing Address - City:BRICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08723-6221
Mailing Address - Country:US
Mailing Address - Phone:732-939-2470
Mailing Address - Fax:732-262-3007
Practice Address - Street 1:125 DRUM POINT RD
Practice Address - Street 2:
Practice Address - City:BRICK
Practice Address - State:NJ
Practice Address - Zip Code:08723-6221
Practice Address - Country:US
Practice Address - Phone:732-920-3338
Practice Address - Fax:732-920-9292
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-18
Last Update Date:2017-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00225500213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8408700Medicaid
NJT51238Medicare UPIN
NJ5862990001Medicare NSC
NJ543759Medicare PIN