Healthcare Provider Details

I. General information

NPI: 1346294212
Provider Name (Legal Business Name): KENNETH WLOCZEWSKI DO
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/22/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

185 ROSEBERRY ST
PHILLIPSBURG NJ
08865-1690
US

IV. Provider business mailing address

4647 TROXELL DR
WHITEHALL PA
18052-1441
US

V. Phone/Fax

Practice location:
  • Phone: 908-859-6700
  • Fax: 908-859-6812
Mailing address:
  • Phone: 610-502-1288
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number25MB080271
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: