Michael E. Kostelnik, MD PA

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

25MA26309 Issued in NJ

Legal business name

MICHAEL E. KOSTELNIK, MD PA

Practice address

52 Main St
Unit One
Succasunna, NJ 07876-1462

Phone

(973) 584-1405

Fax

(973) 584-6889

NPI assigned

Dec 6, 2007

Organization subpart

No

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

Authorized official

Name

Michael E Kostelnik, M.D.

Title

Owner

Phone

(973) 584-1405

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1196899200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1196899200000",
    "number": "1508049115",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "52 MAIN ST",
            "address_2": "UNIT ONE",
            "city": "SUCCASUNNA",
            "state": "NJ",
            "postal_code": "078761462",
            "telephone_number": "973-584-1405",
            "fax_number": "973-584-6889"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "52 MAIN ST",
            "address_2": "UNIT ONE",
            "city": "SUCCASUNNA",
            "state": "NJ",
            "postal_code": "078761462",
            "telephone_number": "973-584-1405",
            "fax_number": "973-584-6889"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MICHAEL E. KOSTELNIK, MD PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-12-06",
        "last_updated": "2007-12-06",
        "status": "A",
        "authorized_official_last_name": "KOSTELNIK",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "973-584-1405",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": "NJ",
            "license": "25MA26309",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2207401",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Internal Medicine Physician in Succasunna, NJ
• Providers in Succasunna, NJ by specialty
• Internal Medicine Physician in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 6, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.