Provider Demographics
NPI:1265918247
Name:TYSAROWSKI, MACIEJ KACPER (MD)
Entity type:Individual
Prefix:
First Name:MACIEJ
Middle Name:KACPER
Last Name:TYSAROWSKI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 JONES ST APT 236
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07103-3841
Mailing Address - Country:US
Mailing Address - Phone:856-283-1728
Mailing Address - Fax:
Practice Address - Street 1:185 S ORANGE AVE # MSBC594
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07103-2757
Practice Address - Country:US
Practice Address - Phone:973-972-3106
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-12
Last Update Date:2018-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program