Doctor Name: | MR. MIECZYSLAW WITEK |
NPI Number: | 1396000576 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | MSN,CRNP |
License Number: | TP006127B |
Business Practice Address: | 21 E Palmer Ave Collingswood, NJ - 081081220 |
Business Phone Number: | 8568581647 |
Business Fax Number: | |
Mailing Address: | 21 E Palmer Ave, COLLINGSWOOD |
State: | NJ |
Postal Code: | 081081220 |
Phone Number: | 8568581647 |
Fax Number: | |
NPI Enumeration Date: | 07/12/2012 |
NPI Last Update Date: | 07/12/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | TP006127B |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | PA |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |