Basic Information
| Provider Information | |||||||||
| NPI: | 1891123204 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | KACZMARSKI BARIATRICS, P.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 280 MIDDLETOWN BLVD | ||||||||
| Address2: | |||||||||
| City: | LANGHORNE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190471816 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 280 MIDDLETOWN BLVD | ||||||||
| Address2: | |||||||||
| City: | LANGHORNE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190471816 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2675723168 | ||||||||
| FaxNumber: | 2675723161 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/22/2013 | ||||||||
| LastUpdateDate: | 10/22/2013 | ||||||||
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| AuthorizedOfficialLastName: | KACZMARSKI | ||||||||
| AuthorizedOfficialFirstName: | CHRISTOPHER | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | SURGEON | ||||||||
| AuthorizedOfficialTelephone: | 2675723168 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D,. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | MD063400L | PA | Y | Hospitals | General Acute Care Hospital |
ID Information
| ID | Type | State | Issuer | Description | 01231790 | 05 | PA | MEDICAID |