Provider Demographics
NPI:1952688590
Name:KONIOR, WOJCIECH (CNS)
Entity Type:Individual
Prefix:
First Name:WOJCIECH
Middle Name:
Last Name:KONIOR
Suffix:
Gender:M
Credentials:CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 BROOKSIDE DR
Mailing Address - Street 2:
Mailing Address - City:OAK RIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07438-9103
Mailing Address - Country:US
Mailing Address - Phone:973-208-0112
Mailing Address - Fax:
Practice Address - Street 1:25 BROOKSIDE DR
Practice Address - Street 2:
Practice Address - City:OAK RIDGE
Practice Address - State:NJ
Practice Address - Zip Code:07438-9103
Practice Address - Country:US
Practice Address - Phone:973-208-0112
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-10
Last Update Date:2011-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCCNS16001133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist