Individual provider Active NPI

Marie Gawronski, PA

  • Physician Assistant
  • Cranford, NJ
National Provider Identifier
1356757199
Registry record updated Sep 9, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
25MP00334900 Issued in NJ
Practice address
570 South Avenue East
Building G, Unit a
Cranford, NJ 07016
Phone
(908) 272-7990
Fax
(908) 272-7970
NPI assigned
Jul 1, 2014
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 9, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 25MP00334900 NJ Primary

Addresses

Primary practice location

570 South Avenue East
Building G, Unit a
Cranford, NJ 07016

Mailing address

570 South Ave East
BLDG G, Unit a
Cranford, NJ 07016
Phone (908) 272-7990

Other practice location 1

264 Boyden Ave
Maplewood, NJ 07040-3070
Phone (973) 761-5722

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150828001128 NJ Practitioner - Physician Assistant 7214243708 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
25MP00334900NJMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Optum Medical Care of New Jersey PC CurrentSince Aug 1, 2019 Accepting new patients

Locations

935 River Rd
Ste 301
Edgewater, NJ 07020
Phone (201) 471-7012

3403 S Delsea Dr
Vineland, NJ 08360
Phone (856) 293-6974

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1404172800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1567987200000",
    "number": "1356757199",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "570 SOUTH AVE EAST",
            "address_2": "BLDG G, UNIT A",
            "city": "CRANFORD",
            "state": "NJ",
            "postal_code": "07016",
            "telephone_number": "908-272-7990"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "570 SOUTH AVENUE EAST",
            "address_2": "BUILDING G, UNIT A",
            "city": "CRANFORD",
            "state": "NJ",
            "postal_code": "07016",
            "telephone_number": "908-272-7990",
            "fax_number": "908-272-7970"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "264 Boyden Ave",
            "address_purpose": "LOCATION",
            "city": "Maplewood",
            "state": "NJ",
            "postal_code": "070403070",
            "country_code": "US",
            "telephone_number": "973-761-5722",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GAWRONSKI",
        "first_name": "MARIE",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-07-01",
        "last_updated": "2019-09-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NJ",
            "license": "25MP00334900",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Cranford, NJ

Sources for this page

Verify at the official NPI Registry.