MEDICARE: DR. JANUSZ S KORNICKI MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	25MA04135100	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1013914035
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JANUSZ S KORNICKI MD

Provider Business Mailing Address
First Line	:	1130 RARITAN RD
Second Line	:
City	:	CRANFORD
State	:	NJ
Zip	:	07016-3328
Country	:	US
Telephone Number	:	908-276-6644
Fax Number	:	908-276-3862

Provider Business Practice Location Address
First Line	:	1130 RARITAN RD
Second Line	:
City	:	CRANFORD
State	:	NJ
Zip	:	07016-3328
Country	:	US
Telephone Number	:	908-276-6644
Fax Number	:	908-276-3862

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/05/2005
Last Update Date	:	10/23/2007

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