Provider Demographics
NPI:1861408569
Name:NIWINSKI, ALICE (PA)
Entity type:Individual
Prefix:
First Name:ALICE
Middle Name:
Last Name:NIWINSKI
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 425
Mailing Address - Street 2:
Mailing Address - City:LEDERACH
Mailing Address - State:PA
Mailing Address - Zip Code:19450-0425
Mailing Address - Country:US
Mailing Address - Phone:800-528-0006
Mailing Address - Fax:732-349-6030
Practice Address - Street 1:140 NUTT ROAD
Practice Address - Street 2:
Practice Address - City:PHOENIXVILLE
Practice Address - State:PA
Practice Address - Zip Code:19460
Practice Address - Country:US
Practice Address - Phone:610-983-1221
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2011-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA002944L207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
S90895Medicare UPIN
PA077018RPCMedicare ID - Type Unspecified