MEDICARE: DR. ALICJA T UCZKOWSKA 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	208000000X	Pediatrics Physician	25MA07239500	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2256004000	OTHER	NJ	AMERIHEALTH OF NJ

General Provider Information

NPI Number	:	1245288091
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALICJA T UCZKOWSKA MD

Provider Business Mailing Address
First Line	:	54 PLAUDERVILLE AVE
Second Line	:	SUITE 3
City	:	GARFIELD
State	:	NJ
Zip	:	07026-2252
Country	:	US
Telephone Number	:	973-772-0262
Fax Number	:	973-772-0265

Provider Business Practice Location Address
First Line	:	54 PLAUDERVILLE AVE
Second Line	:	SUITE 3
City	:	GARFIELD
State	:	NJ
Zip	:	07026-2252
Country	:	US
Telephone Number	:	973-772-0262
Fax Number	:	973-772-0265

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

Provider Enumeration Date	:	05/04/2006
Last Update Date	:	01/25/2013

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