Provider Demographics
NPI:1710932959
Name:HUSKOWSKI, PIOTR (MD)
Entity Type:Individual
Prefix:
First Name:PIOTR
Middle Name:
Last Name:HUSKOWSKI
Suffix:
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 1:1005 CLIFTON AVENUE
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07013
Mailing Address - Country:US
Mailing Address - Phone:973-778-7882
Mailing Address - Fax:973-778-3827
Practice Address - Street 1:1005 CLIFTON AVE
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07013
Practice Address - Country:US
Practice Address - Phone:973-778-7882
Practice Address - Fax:973-778-3827
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-24
Last Update Date:2010-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06677700207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7452900Medicaid
NJ003393Medicare PIN
NJ7452900Medicaid