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General NPI Number Information
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NPI Number | 1497732598
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Entity Type | Individual
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Provider Name | JESSE JOSEPH STAWICKI D.O.
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Gender | Male
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Dates
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Enumeration Date | 12/29/2005
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Last Update Date | 10/13/2011
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Provider Practice Location Address
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Address Line | 1235 WHITEHORSE MERCERVILLE RD SUITE 316 BLDG. C
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City | MERCERVILLE
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State | NJ
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Zip | 08619-3810
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Country | US
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Telephone | 609-581-5586
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Fax | 609-581-5779
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Provider Business Mailing Address
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Address Line | 9 HAMTON CT E
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City | ROBBINSVILLE
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State | NJ
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Zip | 08691-3640
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Country | US
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Telephone | 609-581-5586
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Fax | 609-581-5779
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | MB46599
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License Number State | NJ
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