Healthcare Provider Details

I. General information

NPI: 1689656043
Provider Name (Legal Business Name): JOHN PAUL SWIDRYK SR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/18/2005
Last Update Date: 09/16/2022
Certification Date: 09/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

403 RIVER RD
FAIR HAVEN NJ
07704-3029
US

IV. Provider business mailing address

403 RIVER RD
FAIR HAVEN NJ
07704-3029
US

V. Phone/Fax

Practice location:
  • Phone: 732-842-6727
  • Fax: 732-842-7901
Mailing address:
  • Phone: 732-842-6727
  • Fax: 732-842-7901

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number29119
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: