Healthcare Provider Details

I. General information

NPI: 1619490950
Provider Name (Legal Business Name): MAREK BELZ LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

65 N MAPLE AVE STE 104
RIDGEWOOD NJ
07450-3233
US

IV. Provider business mailing address

65 N MAPLE AVE STE 104
RIDGEWOOD NJ
07450-3233
US

V. Phone/Fax

Practice location:
  • Phone: 374-840-3917
  • Fax:
Mailing address:
  • Phone: 374-840-3917
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number25MA09259100
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License Number25MA09259100
License Number StateNJ

VIII. Authorized Official

Name: TOMASZ OSZCZEPALSKI
Title or Position: MANAGER
Credential:
Phone: 973-495-8518