Provider Demographics
NPI:1972670313
Name:CIENCEWICKI, MICHAEL (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:CIENCEWICKI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51 SANDALWOOD DR
Mailing Address - Street 2:
Mailing Address - City:MARLBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:07746-2114
Mailing Address - Country:US
Mailing Address - Phone:732-577-0636
Mailing Address - Fax:732-577-2877
Practice Address - Street 1:51 SANDALWOOD DR
Practice Address - Street 2:
Practice Address - City:MARLBORO
Practice Address - State:NJ
Practice Address - Zip Code:07746-2114
Practice Address - Country:US
Practice Address - Phone:732-577-0636
Practice Address - Fax:732-577-2877
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA035539207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
0K09567OtherHEALTHNET
NJ3038301Medicaid
0650641001OtherAMERIHEALTH
2354772OtherAETNA
2354772OtherAETNA
0650641001OtherAMERIHEALTH