Healthcare Provider Details

I. General information

NPI: 1669817748
Provider Name (Legal Business Name): MR. MICHAEL MATTHEW TRZCIENSKI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/03/2013
Last Update Date: 05/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

776 MOUNTAIN BLVD STE 106
WATCHUNG NJ
07069-6269
US

IV. Provider business mailing address

104 VILLAGE COMMONS
FLEMINGTON NJ
08822-1732
US

V. Phone/Fax

Practice location:
  • Phone: 732-469-9996
  • Fax:
Mailing address:
  • Phone: 908-421-5326
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License NumberLA10095
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: