MEDICARE: CLIFTON-WALLINGTON MEDICAL GROUP

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

General Provider Information

NPI Number	:	1568401495
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CLIFTON-WALLINGTON MEDICAL GROUP

Provider Business Mailing Address
First Line	:	1033 CLIFTON AVE
Second Line	:	SUITE 210
City	:	CLIFTON
State	:	NJ
Zip	:	07013-3517
Country	:	US
Telephone Number	:	973-473-4400
Fax Number	:

Provider Business Practice Location Address
First Line	:	62 MAIN AVE
Second Line	:
City	:	WALLINGTON
State	:	NJ
Zip	:	07057-1134
Country	:	US
Telephone Number	:	973-471-3555
Fax Number	:	973-471-5353

Authorized Official
Title or Position	:	OWNER/DIRECTOR
Name	:	MRS. KRYSTYNA SZEWCZYK-SZCZECH
Credential	:	M.D
Telephone Number	:	973-473-4400

Provider Enumeration Date	:	06/06/2006
Last Update Date	:	08/22/2020

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