Provider Demographics
NPI:1689656043
Name:SWIDRYK, JOHN PAUL SR (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:PAUL
Last Name:SWIDRYK
Suffix:SR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:403 RIVER RD
Mailing Address - Street 2:
Mailing Address - City:FAIR HAVEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07704-3029
Mailing Address - Country:US
Mailing Address - Phone:732-842-6727
Mailing Address - Fax:732-842-7901
Practice Address - Street 1:403 RIVER RD
Practice Address - Street 2:
Practice Address - City:FAIR HAVEN
Practice Address - State:NJ
Practice Address - Zip Code:07704-3029
Practice Address - Country:US
Practice Address - Phone:732-842-6727
Practice Address - Fax:732-842-7901
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-18
Last Update Date:2022-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ29119207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FO6654OtherHEALTHNET INS CO
NJ1776002Medicaid
FO6654OtherHEALTHNET INS CO
NJ1776002Medicaid
SW84119Medicare ID - Type Unspecified