Provider Demographics
NPI:1730291279
Name:STAWICKI AND PATNAIK MEDICAL ASSOCIATES, P.C.
Entity Type:Organization
Organization Name:STAWICKI AND PATNAIK MEDICAL ASSOCIATES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE/BILLING MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CANDACE
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:SANDOW-KAISER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:609-581-5586
Mailing Address - Street 1:1235 WHITEHORSE MERCERVILLE RD
Mailing Address - Street 2:SUITE 316 BLDG. C
Mailing Address - City:MERCERVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08619-3810
Mailing Address - Country:US
Mailing Address - Phone:609-581-5586
Mailing Address - Fax:609-581-5779
Practice Address - Street 1:1235 WHITEHORSE MERCERVILLE RD
Practice Address - Street 2:SUITE 316 BLDG. C
Practice Address - City:MERCERVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08619-3810
Practice Address - Country:US
Practice Address - Phone:609-581-5586
Practice Address - Fax:609-581-5779
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2015-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1497732598207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0574375OtherAETNA HEALTHCARE
NJ05793468OtherTRADITIONAL AETNA
NJ1575075OtherCIGNA GROUP
NJ1941543OtherUNITED HEALTHCARE
NJ8155305OtherMEDICAID
NJG1942701OtherOXFORD HEALTHPLANS
NJ035105OtherMEDICARE
NJ733224000OtherAMERIHEALTH 65
NJCH0960OtherMEDICARE RAILROAD/GRP