Provider Demographics
NPI:1518989037
Name:SWANNICK-KONOPCZYNSKI, KRYSTINE (MD)
Entity Type:Individual
Prefix:
First Name:KRYSTINE
Middle Name:
Last Name:SWANNICK-KONOPCZYNSKI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KRYSTINE
Other - Middle Name:
Other - Last Name:SWANNICK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1213 PIPER BLVD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34110-1393
Mailing Address - Country:US
Mailing Address - Phone:239-254-0099
Mailing Address - Fax:239-254-1908
Practice Address - Street 1:1213 PIPER BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34110-1393
Practice Address - Country:US
Practice Address - Phone:239-254-0099
Practice Address - Fax:239-254-1908
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2013-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07293000207RN0300X
NJMA072930207RN0300X
FLME108633207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0038954Medicaid
117802Medicare PIN
NJI16920Medicare UPIN