Provider Demographics
NPI:1598088585
Name:GIZIENSKI, RAYMOND J (RPH)
Entity Type:Individual
Prefix:MR
First Name:RAYMOND
Middle Name:J
Last Name:GIZIENSKI
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 KOEWING PL
Mailing Address - Street 2:
Mailing Address - City:WEST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07052-3928
Mailing Address - Country:US
Mailing Address - Phone:973-736-9809
Mailing Address - Fax:
Practice Address - Street 1:230 E RIDGEWOOD AVE
Practice Address - Street 2:BERGEN REGIONAL MEDICAL CENTER
Practice Address - City:PARAMUS
Practice Address - State:NJ
Practice Address - Zip Code:07652-4142
Practice Address - Country:US
Practice Address - Phone:201-967-4175
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-05
Last Update Date:2010-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI02985600183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist