Provider Demographics
NPI:1700844784
Name:SWIBINSKI, EDWARD THOMAS (MD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:THOMAS
Last Name:SWIBINSKI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1210 BRACE RD
Mailing Address - Street 2:SUITE 107
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08034-3213
Mailing Address - Country:US
Mailing Address - Phone:856-795-3597
Mailing Address - Fax:856-795-7590
Practice Address - Street 1:1210 BRACE RD
Practice Address - Street 2:SUITE 107
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08034-3213
Practice Address - Country:US
Practice Address - Phone:856-795-3597
Practice Address - Fax:856-795-7590
Is Sole Proprietor?:No
Enumeration Date:2006-05-01
Last Update Date:2010-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03470200207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1478001Medicaid
NJC57236Medicare UPIN
NJ1478001Medicaid