Provider Demographics
NPI:1760467294
Name:ADAMCZYK, ROBERT K (PA C)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:K
Last Name:ADAMCZYK
Suffix:
Gender:M
Credentials:PA C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1105 CRANBROOK RD
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:NJ
Mailing Address - Zip Code:07083-6328
Mailing Address - Country:US
Mailing Address - Phone:410-991-6280
Mailing Address - Fax:
Practice Address - Street 1:150 HINCHMAN AVE STE 4
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470
Practice Address - Country:US
Practice Address - Phone:973-595-6996
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-07
Last Update Date:2019-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0002239363A00000X
NJ25MP00016400363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant