Provider Demographics
NPI:1104801331
Name:WIERZBICKI, JONATHAN E (MD)
Entity type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:E
Last Name:WIERZBICKI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:4 WALTER E FORAN BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:FLEMINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08822-4665
Mailing Address - Country:US
Mailing Address - Phone:908-824-7179
Mailing Address - Fax:908-824-7684
Practice Address - Street 1:4 WALTER E FORAN BLVD STE 101
Practice Address - Street 2:
Practice Address - City:FLEMINGTON
Practice Address - State:NJ
Practice Address - Zip Code:08822-4665
Practice Address - Country:US
Practice Address - Phone:908-824-7179
Practice Address - Fax:908-824-7684
Is Sole Proprietor?:No
Enumeration Date:2005-12-09
Last Update Date:2024-06-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJMA06780800207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJH73295Medicare UPIN