Provider Demographics
NPI:1770656597
Name:KINDZIERSKI, MICHAEL ADAM (DO)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:ADAM
Last Name:KINDZIERSKI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:76 CARTERET AVE
Mailing Address - Street 2:
Mailing Address - City:CARTERET
Mailing Address - State:NJ
Mailing Address - Zip Code:07008-2517
Mailing Address - Country:US
Mailing Address - Phone:732-541-9060
Mailing Address - Fax:732-541-9220
Practice Address - Street 1:76 CARTERET AVE
Practice Address - Street 2:
Practice Address - City:CARTERET
Practice Address - State:NJ
Practice Address - Zip Code:07008-2517
Practice Address - Country:US
Practice Address - Phone:732-541-9060
Practice Address - Fax:732-541-9220
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJBK 4607416207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7206402Medicaid
NJ7206402Medicaid
NJKI752446Medicare ID - Type Unspecified