Provider Demographics
NPI:1285859488
Name:KOCIUBA, MARCIN K (DO)
Entity type:Individual
Prefix:DR
First Name:MARCIN
Middle Name:K
Last Name:KOCIUBA
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 1:66 WEST GILBERT ST
Mailing Address - Street 2:2ND FL
Mailing Address - City:RED BANK
Mailing Address - State:NJ
Mailing Address - Zip Code:07701
Mailing Address - Country:US
Mailing Address - Phone:732-212-0051
Mailing Address - Fax:
Practice Address - Street 1:10 HURON AVE
Practice Address - Street 2:APT 7E
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07306-3641
Practice Address - Country:US
Practice Address - Phone:201-259-3969
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-16
Last Update Date:2008-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB08197300207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0132446Medicaid
NJ0132446Medicaid
NJ111371Medicare PIN
NJ111371UWXMedicare PIN