MEDICARE: MADELYN CLAIRE CZUPICH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	MA062364	PA

General Provider Information

NPI Number	:	1376111591
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MADELYN CLAIRE CZUPICH

Provider Business Mailing Address
First Line	:	2 PARK WAY
Second Line	:
City	:	UPPER SADDLE RIVER
State	:	NJ
Zip	:	07458-2345
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2 PARK WAY
Second Line	:
City	:	UPPER SADDLE RIVER
State	:	NJ
Zip	:	07458-2345
Country	:	US
Telephone Number	:	201-882-7526
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/14/2021
Last Update Date	:	08/16/2023

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Directions to “ MADELYN CLAIRE CZUPICH ” Practice Location

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