Provider Demographics
NPI:1356757199
Name:GAWRONSKI, MARIE (PA)
Entity type:Individual
Prefix:
First Name:MARIE
Middle Name:
Last Name:GAWRONSKI
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:570 SOUTH AVE EAST
Mailing Address - Street 2:BLDG G, UNIT A
Mailing Address - City:CRANFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:07016
Mailing Address - Country:US
Mailing Address - Phone:908-272-7990
Mailing Address - Fax:
Practice Address - Street 1:570 SOUTH AVENUE EAST
Practice Address - Street 2:BUILDING G, UNIT A
Practice Address - City:CRANFORD
Practice Address - State:NJ
Practice Address - Zip Code:07016
Practice Address - Country:US
Practice Address - Phone:908-272-7990
Practice Address - Fax:908-272-7970
Is Sole Proprietor?:No
Enumeration Date:2014-07-01
Last Update Date:2019-09-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MP00334900363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant