Provider Demographics
NPI:1487735783
Name:KAZANSKI, MARY E (MD)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:E
Last Name:KAZANSKI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:419 N HARRISON ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:PRINCETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08540-3521
Mailing Address - Country:US
Mailing Address - Phone:609-924-9300
Mailing Address - Fax:609-430-9481
Practice Address - Street 1:419 N HARRISON ST
Practice Address - Street 2:SUITE 201
Practice Address - City:PRINCETON
Practice Address - State:NJ
Practice Address - Zip Code:08540-3521
Practice Address - Country:US
Practice Address - Phone:609-924-9300
Practice Address - Fax:609-430-9481
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2010-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA04925400207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1811100OtherUNITEDHEALTHC-SPECIALTY
NJ900586OtherAETNA-SPECIALTY
NJ0203910000OtherAMERIHLTH/IBC SPECIALTY
NJMEP071OtherOXFORD-SPECIALTY
NJ160032337OtherRAILROAD MED.-PRINCETON
NJ160032342OtherRAILROAD MED.MONROE
NJ3066509Medicaid
NJ196649OtherAMERIHLTH ADMIN SPECIALTY
NJ1811100OtherUNITEDHEALTHC-SPECIALTY