Basic Information
| Provider Information | |||||||||
| NPI: | 1588624860 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SIWINSKI | ||||||||
| FirstName: | DENISE | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2301 E ALLEGHENY AVENUE | ||||||||
| Address2: | 1 | ||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 19134 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2152913107 | ||||||||
| FaxNumber: | 2152913112 | ||||||||
| Practice Location | |||||||||
| Address1: | 731 HIGHWAY 35 UNIT G | ||||||||
| Address2: | |||||||||
| City: | OCEAN | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 077124765 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7324558444 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/23/2006 | ||||||||
| LastUpdateDate: | 04/21/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/21/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | MD418686 | PA | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 25MA06634500 | NJ | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 8067104 | 05 | NJ | MEDICAID | 0018968970004 | 05 | PA | MEDICAID |