Provider Demographics
NPI:1164685764
Name:JOHN T SCHWIKA, D.O. LLC
Entity type:Organization
Organization Name:JOHN T SCHWIKA, D.O. LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:THEODORE
Authorized Official - Last Name:SCHWIKA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:609-707-4408
Mailing Address - Street 1:PO BOX 125
Mailing Address - Street 2:
Mailing Address - City:ESTELL MANOR
Mailing Address - State:NJ
Mailing Address - Zip Code:08319-0125
Mailing Address - Country:US
Mailing Address - Phone:609-707-4408
Mailing Address - Fax:
Practice Address - Street 1:650 S WHITE HORSE PIKE
Practice Address - Street 2:
Practice Address - City:HAMMONTON
Practice Address - State:NJ
Practice Address - Zip Code:08037-2008
Practice Address - Country:US
Practice Address - Phone:609-707-4408
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-03
Last Update Date:2008-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB078217207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJI70728Medicare UPIN