Provider Demographics
NPI:1548209315
Name:CLIFTON-WALLINGTON MEDICAL GROUP
Entity Type:Organization
Organization Name:CLIFTON-WALLINGTON MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KRYSTYNA
Authorized Official - Middle Name:
Authorized Official - Last Name:SZEWCZYK-SZCZECH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-473-4400
Mailing Address - Street 1:1033 CLIFTON AVE
Mailing Address - Street 2:SUITE 210
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07013-3517
Mailing Address - Country:US
Mailing Address - Phone:973-473-4400
Mailing Address - Fax:973-473-6800
Practice Address - Street 1:1033 CLIFTON AVE
Practice Address - Street 2:SUITE 210
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07013-3517
Practice Address - Country:US
Practice Address - Phone:973-473-4400
Practice Address - Fax:973-473-6800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-06
Last Update Date:2013-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ069164Medicare ID - Type UnspecifiedGROUP PROVIDER NUMBER