Healthcare Provider Details

I. General information

NPI: 1932315520
Provider Name (Legal Business Name): STEVEN J. CISZEWSKI PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2007
Last Update Date: 07/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2415 MATLOCK RD
ARLINGTON TX
76015-1619
US

IV. Provider business mailing address

2415 MATLOCK RD
ARLINGTON TX
76015-1619
US

V. Phone/Fax

Practice location:
  • Phone: 817-277-6444
  • Fax: 817-548-7329
Mailing address:
  • Phone: 817-277-6444
  • Fax: 817-548-7329

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA00200
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: