Provider Demographics
NPI:1184895864
Name:RICHARD E KWASNIK
Entity type:Organization
Organization Name:RICHARD E KWASNIK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:E
Authorized Official - Last Name:KWASNIK
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:856-429-1859
Mailing Address - Street 1:PO BOX 1156
Mailing Address - Street 2:
Mailing Address - City:HADDONFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:08033-0709
Mailing Address - Country:US
Mailing Address - Phone:856-429-1859
Mailing Address - Fax:856-354-2111
Practice Address - Street 1:205 N HADDON AVE
Practice Address - Street 2:
Practice Address - City:HADDONFIELD
Practice Address - State:NJ
Practice Address - Zip Code:08033-2322
Practice Address - Country:US
Practice Address - Phone:856-429-1859
Practice Address - Fax:856-354-2111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-20
Last Update Date:2008-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3544303Medicaid
NJT28606Medicare UPIN
NJ0493440001Medicare NSC