Provider Demographics
NPI:1760758148
Name:SWIERCZYNSKI, MICHAEL (RRA)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:SWIERCZYNSKI
Suffix:
Gender:M
Credentials:RRA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 FIRETHORN LN
Mailing Address - Street 2:
Mailing Address - City:SICKLERVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08081-4154
Mailing Address - Country:US
Mailing Address - Phone:856-304-5986
Mailing Address - Fax:
Practice Address - Street 1:8 FIRETHORN LN
Practice Address - Street 2:
Practice Address - City:SICKLERVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08081-4154
Practice Address - Country:US
Practice Address - Phone:856-304-5986
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-29
Last Update Date:2012-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ6249432471C1101X
NY9144622471V0106X
NY000189243U00000X, 261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes243U00000XTechnologists, Technicians & Other Technical Service ProvidersRadiology Practitioner Assistant
No2471C1101XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistCardiovascular-Interventional Technology
No2471V0106XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistVascular-Interventional Technology
No261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology