Provider Demographics
NPI:1144264664
Name:TRZESNIOWSKI, JOHN G (DO)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:G
Last Name:TRZESNIOWSKI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2716 E ALLEGHENY AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19134-5916
Mailing Address - Country:US
Mailing Address - Phone:215-426-3610
Mailing Address - Fax:215-426-6835
Practice Address - Street 1:2716 E ALLEGHENY AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19134-5916
Practice Address - Country:US
Practice Address - Phone:215-426-3610
Practice Address - Fax:215-426-6835
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS003175L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0058140001OtherKEYSTONE HEALTH PLAN
PA1002402OtherKEYSTONE MERCY
PA11019OtherELDER HEALTH
PA4102250OtherAETNA
PA0006115620002Medicaid
PA173956OtherPENNSYLVANIA BLUE SHIELD
PA28293OtherHEALTH PARTNERS
PA11019OtherELDER HEALTH
PA173956Medicare ID - Type Unspecified