Provider Demographics
NPI:1588624860
Name:SIWINSKI, DENISE (MD)
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:
Last Name:SIWINSKI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2301 E ALLEGHENY AVENUE
Mailing Address - Street 2:1
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19134
Mailing Address - Country:US
Mailing Address - Phone:215-291-3107
Mailing Address - Fax:215-291-3112
Practice Address - Street 1:731 HIGHWAY 35 UNIT G
Practice Address - Street 2:
Practice Address - City:OCEAN
Practice Address - State:NJ
Practice Address - Zip Code:07712-4765
Practice Address - Country:US
Practice Address - Phone:732-455-8444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2020-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD418686207Q00000X
NJ25MA06634500207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8067104Medicaid
PA0018968970004Medicaid
NJ8067104Medicaid
NJ038155R63Medicare PIN
NJ038155YBAWMedicare PIN
PA0018968970004Medicaid