Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | 25MD00100100 | NJ |
Y | 222Z00000X | Podiatrist | 25MD00100100 | NJ |
NPI | 1023003571 |
---|---|
Provider Name | Dr. Richard E Kwasnik |
First Address | Haddonfield, NJ 08033-0709 |
Second Address | Haddonfield, NJ 08033-2322 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/09/2005 |
Last Update Date | 04/08/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
354430301 | (05) | NJ |
T28606 | (02) |