Provider Demographics
NPI:1720187859
Name:WAWRZYNIAK, ZYGMUNT (MD)
Entity Type:Individual
Prefix:
First Name:ZYGMUNT
Middle Name:
Last Name:WAWRZYNIAK
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 1:520 N WOOD AVE
Mailing Address - Street 2:
Mailing Address - City:LINDEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07036-4147
Mailing Address - Country:US
Mailing Address - Phone:908-587-9300
Mailing Address - Fax:908-587-1901
Practice Address - Street 1:520 N WOOD AVE
Practice Address - Street 2:
Practice Address - City:LINDEN
Practice Address - State:NJ
Practice Address - Zip Code:07036-4147
Practice Address - Country:US
Practice Address - Phone:908-587-9300
Practice Address - Fax:908-587-1901
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-22
Last Update Date:2020-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA56480207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5560101Medicaid
NJ5560101Medicaid
WA835467Medicare PIN