Provider Demographics
NPI:1518055755
Name:KACZAJ, OLGA (MD)
Entity Type:Individual
Prefix:
First Name:OLGA
Middle Name:
Last Name:KACZAJ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1317 S MAIN RD
Mailing Address - Street 2:UNIT 2C
Mailing Address - City:VINELAND
Mailing Address - State:NJ
Mailing Address - Zip Code:08360-6511
Mailing Address - Country:US
Mailing Address - Phone:856-213-6080
Mailing Address - Fax:856-213-6092
Practice Address - Street 1:1317 S MAIN RD
Practice Address - Street 2:UNIT 2C
Practice Address - City:VINELAND
Practice Address - State:NJ
Practice Address - Zip Code:08360-6511
Practice Address - Country:US
Practice Address - Phone:856-213-6080
Practice Address - Fax:856-213-6092
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2011-11-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NJMA072892207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ069245YFJ5Medicare PIN