Healthcare Provider Details

I. General information

NPI: 1396807194
Provider Name (Legal Business Name): JOHN R. SKOWRONSKI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 E BLACK HORSE PIKE
PLEASANTVILLE NJ
08232-2737
US

IV. Provider business mailing address

29 GOLF VIEW DR
LITTLE EGG HARBOR NJ
08087-4219
US

V. Phone/Fax

Practice location:
  • Phone: 609-641-9009
  • Fax: 609-641-6918
Mailing address:
  • Phone: 609-296-0874
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number25MA02089100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: