Provider Demographics
NPI:1508813007
Name:SOBIESZCZYK, SYLWESTER MIECZYSLAW (MD)
Entity Type:Individual
Prefix:MR
First Name:SYLWESTER
Middle Name:MIECZYSLAW
Last Name:SOBIESZCZYK
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 548
Mailing Address - Street 2:
Mailing Address - City:BERLIN
Mailing Address - State:NJ
Mailing Address - Zip Code:08009-0548
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:603 N BROAD ST
Practice Address - Street 2:SUITE 200
Practice Address - City:WOODBURY
Practice Address - State:NJ
Practice Address - Zip Code:08096-1619
Practice Address - Country:US
Practice Address - Phone:856-853-1111
Practice Address - Fax:856-853-1288
Is Sole Proprietor?:No
Enumeration Date:2006-05-28
Last Update Date:2007-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05604100207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3301303Medicaid
472225Medicare PIN
F74783Medicare UPIN