Provider Demographics
NPI:1518020296
Name:PAWLIW, MYRON (MD)
Entity Type:Individual
Prefix:
First Name:MYRON
Middle Name:
Last Name:PAWLIW
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 1:253 WITHERSPOON ST
Mailing Address - Street 2:MEDICAL ARTS BUILDING SUITE G
Mailing Address - City:PRINCETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08540-3211
Mailing Address - Country:US
Mailing Address - Phone:609-924-5365
Mailing Address - Fax:609-924-5611
Practice Address - Street 1:253 WITHERSPOON ST
Practice Address - Street 2:MEDICAL ARTS BUILDING SUITE G
Practice Address - City:PRINCETON
Practice Address - State:NJ
Practice Address - Zip Code:08540-3211
Practice Address - Country:US
Practice Address - Phone:609-924-5365
Practice Address - Fax:609-924-5611
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA04398900207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
190024Medicare ID - Type Unspecified
NJA64071Medicare UPIN