Provider Demographics
NPI:1649522467
Name:MARIA G. PYONTEK, LLC
Entity type:Organization
Organization Name:MARIA G. PYONTEK, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:G
Authorized Official - Last Name:PYONTEK
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:732-681-1063
Mailing Address - Street 1:1725 HIGHWAY 35
Mailing Address - Street 2:SUITE B
Mailing Address - City:WALL
Mailing Address - State:NJ
Mailing Address - Zip Code:07719-3488
Mailing Address - Country:US
Mailing Address - Phone:732-681-1063
Mailing Address - Fax:732-681-2922
Practice Address - Street 1:1725 HIGHWAY 35
Practice Address - Street 2:SUITE B
Practice Address - City:WALL
Practice Address - State:NJ
Practice Address - Zip Code:07719-3488
Practice Address - Country:US
Practice Address - Phone:732-681-1063
Practice Address - Fax:732-681-2922
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-03
Last Update Date:2012-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB06339900207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty