Provider Demographics
NPI:1013920867
Name:MIEDZIAK, ANITA I (MD)
Entity Type:Individual
Prefix:DR
First Name:ANITA
Middle Name:I
Last Name:MIEDZIAK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:419 NORTH HARRISON STREET
Mailing Address - Street 2:SUITE104
Mailing Address - City:PRINCETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08540
Mailing Address - Country:US
Mailing Address - Phone:609-921-9437
Mailing Address - Fax:609-688-9941
Practice Address - Street 1:419 NORTH HARRISON STREET
Practice Address - Street 2:SUITE 104
Practice Address - City:PRINCETON
Practice Address - State:NJ
Practice Address - Zip Code:08540
Practice Address - Country:US
Practice Address - Phone:609-921-9437
Practice Address - Fax:609-688-9941
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2013-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06941700207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8561800Medicaid
NJ030775AMPMedicare PIN
G86093Medicare UPIN
G72146Medicare UPIN
NJ8561800Medicaid