Healthcare Provider Details

I. General information

NPI: 1639265408
Provider Name (Legal Business Name): STEPHEN KWASNIEWSKI PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2501 KUSER RD STE 3
HAMILTON NJ
08691
US

IV. Provider business mailing address

2501 KUSER RD STE 3
HAMILTON NJ
08691-3386
US

V. Phone/Fax

Practice location:
  • Phone: 609-896-0444
  • Fax: 609-896-1126
Mailing address:
  • Phone: 609-896-0444
  • Fax: 609-896-1126

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number25MP00107800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: