Healthcare Provider Details

I. General information

NPI: 1730290974
Provider Name (Legal Business Name): MACIAG AND TAWADROS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 ROSIE SQ
WOOD RIDGE NJ
07075-7002
US

IV. Provider business mailing address

220 ROSIE SQ
WOOD RIDGE NJ
07075-7002
US

V. Phone/Fax

Practice location:
  • Phone: 973-473-2243
  • Fax: 973-473-8387
Mailing address:
  • Phone: 973-473-2243
  • Fax: 973-473-8387

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number28RS00355700
License Number StateNJ
# 4
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number StateNULL
# 5
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number StateNULL

VIII. Authorized Official

Name: RYSZARD MACIAG
Title or Position: MEMBER/MANAGER
Credential:
Phone: 201-320-7272