Healthcare Provider Details

I. General information

NPI: 1700844784
Provider Name (Legal Business Name): EDWARD THOMAS SWIBINSKI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2006
Last Update Date: 10/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1210 BRACE RD SUITE 107
CHERRY HILL NJ
08034-3213
US

IV. Provider business mailing address

1210 BRACE RD SUITE 107
CHERRY HILL NJ
08034-3213
US

V. Phone/Fax

Practice location:
  • Phone: 856-795-3597
  • Fax: 856-795-7590
Mailing address:
  • Phone: 856-795-3597
  • Fax: 856-795-7590

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number25MA03470200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: