Provider Demographics
NPI:1407923774
Name:SWAJIAN, DO, MARY (DO)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:
Last Name:SWAJIAN, DO
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:381 PARK ST SUITE 1A
Mailing Address - Street 2:PARK PROFESSIONAL BLDG
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601
Mailing Address - Country:US
Mailing Address - Phone:201-487-9790
Mailing Address - Fax:201-487-9791
Practice Address - Street 1:381 PARK ST SUITE 1A
Practice Address - Street 2:PARK PROFESSIONAL BLDG
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601
Practice Address - Country:US
Practice Address - Phone:201-487-9790
Practice Address - Fax:201-487-9791
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB03788900208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
439190Medicare ID - Type Unspecified