Provider Demographics
NPI:1639265408
Name:KWASNIEWSKI, STEPHEN (PA)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:
Last Name:KWASNIEWSKI
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2501 KUSER RD STE 3
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08691-3386
Mailing Address - Country:US
Mailing Address - Phone:609-896-0444
Mailing Address - Fax:609-896-1126
Practice Address - Street 1:2501 KUSER RD STE 3
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:NJ
Practice Address - Zip Code:08691
Practice Address - Country:US
Practice Address - Phone:609-896-0444
Practice Address - Fax:609-896-1126
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2023-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00107800363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q03362Medicare UPIN
NJ075836L7UMedicare PIN
PA075289PG0Medicare PIN