Provider Demographics
NPI:1619142965
Name:DZWONAR, JOHN EDWARD (LMSW)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:EDWARD
Last Name:DZWONAR
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 WEST 43RD STREET
Mailing Address - Street 2:APT 35B
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10036-6301
Mailing Address - Country:US
Mailing Address - Phone:212-564-4961
Mailing Address - Fax:
Practice Address - Street 1:400 WEST 43RD STREET
Practice Address - Street 2:APT 35B
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10036-6301
Practice Address - Country:US
Practice Address - Phone:212-564-4961
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-28
Last Update Date:2014-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY72076206104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA300095276Medicare PIN