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General NPI Number Information
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NPI Number | 1013960079
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Entity Type | Individual
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Provider Name | PIOTR KISZA M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/18/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 110 S GROVE ST
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City | EAST ORANGE
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State | NJ
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Zip | 07018-4102
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Country | US
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Telephone | 973-677-1027
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Fax |
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Provider Business Mailing Address
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Address Line | 110 S GROVE ST
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City | EAST ORANGE
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State | NJ
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Zip | 07018-4102
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0204X
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Taxonomy Name | Vascular & Interventional Radiology Physician
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License Number | 25MA07838000
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License Number State | NJ
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