Provider Demographics
NPI:1659304632
Name:WOROCH, SWIATOSLAW B (MD)
Entity type:Individual
Prefix:DR
First Name:SWIATOSLAW
Middle Name:B
Last Name:WOROCH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:89 WEST 43RD ST
Mailing Address - Street 2:
Mailing Address - City:BAYONNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07002
Mailing Address - Country:US
Mailing Address - Phone:201-858-1900
Mailing Address - Fax:201-858-8803
Practice Address - Street 1:89 WEST 43RD ST
Practice Address - Street 2:
Practice Address - City:BAYONNE
Practice Address - State:NJ
Practice Address - Zip Code:07002
Practice Address - Country:US
Practice Address - Phone:201-858-1900
Practice Address - Fax:201-858-8803
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2012-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA0386400207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
0077357OtherGHI
38668OtherAETNA
0077357OtherGHI
38668OtherAETNA