Healthcare Provider Details

I. General information

NPI: 1881618809
Provider Name (Legal Business Name): MICHAEL SWATSKI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 10/06/2023
Certification Date: 10/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

817 FEDERAL STREET
CAMDEN NJ
08103
US

IV. Provider business mailing address

817 FEDERAL STREET SUITE 300
CAMDEN NJ
08103
US

V. Phone/Fax

Practice location:
  • Phone: 856-541-5933
  • Fax: 856-541-3340
Mailing address:
  • Phone: 856-541-5933
  • Fax: 854-541-3340

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number25MA05946700
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier5659809
Identifier TypeMEDICAID
Identifier StateNJ
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: