Provider Demographics
NPI:1487792354
Name:SIEROCKI, JOHN S (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:S
Last Name:SIEROCKI
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 1:419 N HARRISON ST
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08540-3521
Mailing Address - Country:US
Mailing Address - Phone:609-924-9300
Mailing Address - Fax:609-430-9481
Practice Address - Street 1:419 N HARRISON ST
Practice Address - Street 2:SUITE 101
Practice Address - City:PRINCETON
Practice Address - State:NJ
Practice Address - Zip Code:08540-3521
Practice Address - Country:US
Practice Address - Phone:609-924-9300
Practice Address - Fax:609-430-9481
Is Sole Proprietor?:No
Enumeration Date:2007-02-02
Last Update Date:2008-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03428100207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MES085OtherOXFORD SPECIALTY
110137125OtherRAILROAD MED PRINCETON
NJ2441004Medicaid
2593877OtherUNITED HEALTHCARE
0075927000OtherAMERIHLTH IBC SPECIALTY
066852OtherAMERIHLTH ADMIN SPECIALTY
2193643OtherAETNA HMO NONHMO SPEC
MEP075OtherOXFORD PCP
110137134OtherRAILROAD MED MONROE
877480OtherAETNA HMO NONHMO PCP
2193643OtherAETNA HMO NONHMO SPEC
877480OtherAETNA HMO NONHMO PCP