Provider Demographics
NPI:1023003571
Name:KWASNIK, RICHARD E (DPM)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:E
Last Name:KWASNIK
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1156
Mailing Address - Street 2:
Mailing Address - City:HADDONFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:08033-0709
Mailing Address - Country:US
Mailing Address - Phone:856-429-1859
Mailing Address - Fax:856-354-2111
Practice Address - Street 1:205 N HADDON AVE
Practice Address - Street 2:
Practice Address - City:HADDONFIELD
Practice Address - State:NJ
Practice Address - Zip Code:08033-2322
Practice Address - Country:US
Practice Address - Phone:856-429-1859
Practice Address - Fax:856-354-2111
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-12
Last Update Date:2008-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00100100213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ354430301Medicaid
T28606Medicare UPIN
NJ354430301Medicaid