Healthcare Provider Details

I. General information

NPI: 1699942367
Provider Name (Legal Business Name): EWA MARCINKIEWICZ OBRIEN DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

42 LOCUST AVE
WALLINGTON NJ
07057
US

IV. Provider business mailing address

42 LOCUST AVE
WALLINGTON NJ
07057
US

V. Phone/Fax

Practice location:
  • Phone: 973-773-5400
  • Fax:
Mailing address:
  • Phone: 973-773-5400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDI018780
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: