Active NPI
Krzysztof Boleslaw Lichnowski, M.D.
- Internal Medicine Physician
- Brick, NJ
National Provider Identifier
1558334458
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- MA50509
- Practice address
- 204 Jack Martin Blvd
C-3
Brick, NJ 08724-7770 - Phone
- (732) 840-8500
- Fax
- (732) 840-7552
- NPI assigned
- Feb 10, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | MA50509 | NJ | Primary |
Addresses
Primary practice location
204 Jack Martin Blvd
C-3
Brick, NJ 08724-7770
Mailing address
204 Jack Martin Blvd.
C-3
Brick, NJ 08724-3515
Phone (732) 840-8500
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MA50509 | NJ | MD | Internal Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| John Infantolino MD PC | Internal Medicine | Past | Accepting new patients |
| Barnabas Health Medical Group, PC | Internal Medicine | Past | Accepting new patients |
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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Internal Medicine Physician
- Brick, NJ
- NPI 1922248111
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1139529600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1296432000000",
"number": "1558334458",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "204 JACK MARTIN BLVD.",
"address_2": "C-3",
"city": "BRICK",
"state": "NJ",
"postal_code": "087243515",
"telephone_number": "732-840-8500",
"fax_number": "732-840-7552"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "204 JACK MARTIN BLVD",
"address_2": "C-3",
"city": "BRICK",
"state": "NJ",
"postal_code": "087247770",
"telephone_number": "732-840-8500",
"fax_number": "732-840-7552"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LICHNOWSKI",
"first_name": "KRZYSZTOF",
"middle_name": "BOLESLAW",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-02-10",
"last_updated": "2011-01-31",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "NJ",
"license": "MA50509",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Brick, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 31, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.