Healthcare Provider Details

I. General information

NPI: 1669363321
Provider Name (Legal Business Name): PATRICIA GWOZDZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2025
Last Update Date: 07/11/2025
Certification Date: 07/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 POTTERSVILLE RD
CHESTER NJ
07930-2432
US

IV. Provider business mailing address

90 HUNTERS LN
SPARTA NJ
07871-2556
US

V. Phone/Fax

Practice location:
  • Phone: 908-895-4931
  • Fax:
Mailing address:
  • Phone: 973-901-4242
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number26NR27080400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: