Healthcare Provider Details

I. General information

NPI: 1487735783
Provider Name (Legal Business Name): MARY E KAZANSKI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 06/18/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

419 N HARRISON ST SUITE 201
PRINCETON NJ
08540-3521
US

IV. Provider business mailing address

419 N HARRISON ST SUITE 201
PRINCETON NJ
08540-3521
US

V. Phone/Fax

Practice location:
  • Phone: 609-924-9300
  • Fax: 609-430-9481
Mailing address:
  • Phone: 609-924-9300
  • Fax: 609-430-9481

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number25MA04925400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: