Provider Demographics
NPI:1609343086
Name:KALUSZYNER, AVIVA
Entity Type:Individual
Prefix:MRS
First Name:AVIVA
Middle Name:
Last Name:KALUSZYNER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:422 MONMOUTH AVE
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-3210
Mailing Address - Country:US
Mailing Address - Phone:732-917-3304
Mailing Address - Fax:
Practice Address - Street 1:422 MONMOUTH AVE
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-3210
Practice Address - Country:US
Practice Address - Phone:732-917-3304
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-24
Last Update Date:2018-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJCAPPA374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
No374J00000XNursing Service Related ProvidersDoulaGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ815122844000Medicaid