Provider Demographics
NPI:1497732598
Name:STAWICKI, JESSE JOSEPH (DO)
Entity Type:Individual
Prefix:DR
First Name:JESSE
Middle Name:JOSEPH
Last Name:STAWICKI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9 HAMTON CT E
Mailing Address - Street 2:
Mailing Address - City:ROBBINSVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08691-3640
Mailing Address - Country:US
Mailing Address - Phone:609-581-5586
Mailing Address - Fax:609-581-5779
Practice Address - Street 1:1235 WHITEHORSE MERCERVILLE RD
Practice Address - Street 2:SUITE 316 BLDG. C
Practice Address - City:MERCERVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08619-3810
Practice Address - Country:US
Practice Address - Phone:609-581-5586
Practice Address - Fax:609-581-5779
Is Sole Proprietor?:No
Enumeration Date:2005-12-29
Last Update Date:2011-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMB46599207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1K3956OtherPHS/HEALTHNET
NJ2261107OtherAETNA
NJ223709512OtherGREAT WEST
NJ5404703Medicaid
NJMEP111OtherOXFORD
NJ223709512OtherHORIZON
NJ4208912OtherTRADITIONAL AETNA
NJ047593100OtherAMERIHEALTH/KEYSTONE/PERS
NJ110207564OtherMEDICARE RAILROAD
NJ645148OtherAMERIHEALTH ADMIN.
NJ0927766OtherCIGNA
NJ2158854000OtherAMERIHEALTH 65
NJ987766OtherUNITED HEALTHCARE
NJ223709512OtherHORIZON
NJ035105Medicare ID - Type UnspecifiedN.J. MEDICARE