Healthcare Provider Details

I. General information

NPI: 1336310788
Provider Name (Legal Business Name): DIANA EWA HUZAR DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/13/2008
Last Update Date: 03/05/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

249 STATE RT 94
VERNON NJ
07462-0739
US

IV. Provider business mailing address

402 LIPPINCOTT DR
MARLTON NJ
08053-4112
US

V. Phone/Fax

Practice location:
  • Phone: 973-827-4550
  • Fax: 973-827-5845
Mailing address:
  • Phone: 856-782-3300
  • Fax: 856-504-8029

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number25MB08556600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: