Individual provider Active NPI

Halina M Kedziora, M.D.

  • Internal Medicine Physician
  • Stratford, NJ
National Provider Identifier
1871573782
Registry record updated Apr 15, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
MA06324100 Issued in NJ
Practice address
42 Laurel Rd E
Udp #1800
Stratford, NJ 08084-1354
Phone
(856) 566-6843
Fax
(856) 566-6419
NPI assigned
Jan 18, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 15, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X MA06324100 NJ Primary

Addresses

Primary practice location

42 Laurel Rd E
Udp #1800
Stratford, NJ 08084-1354

Mailing address

42 E Laurel Rd
Udp 1800
Stratford, NJ 08084-1354
Phone (856) 566-6843

Other identifiers 1

IdentifierTypeStateIssuer
7182902MedicaidNJ

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050713000793 NJ Practitioner - Internal MedicinePractitioner - Geriatric Medicine 0547296279

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
MA06324100NJMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Rowansom New Jersey Institute for Successful Aging Internal Medicine CurrentSince Nov 20, 1995 Accepting new patients
Rowansom Newjersey Institute for Successful Aging-Geriatric Psychiatry Current Accepting new patients

Locations

42 E Laurel Rd
Ste 3200
Stratford, NJ 08084
Phone (609) 566-6843

42 E Laurel Rd
Ste 1800
Stratford, NJ 08084
Phone (609) 566-6843

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": "1137542400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1460678400000",
    "number": "1871573782",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "42 E LAUREL RD",
            "address_2": "UDP 1800",
            "city": "STRATFORD",
            "state": "NJ",
            "postal_code": "080841354",
            "telephone_number": "856-566-6843",
            "fax_number": "856-566-6419"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "42 LAUREL RD E",
            "address_2": "UDP #1800",
            "city": "STRATFORD",
            "state": "NJ",
            "postal_code": "080841354",
            "telephone_number": "856-566-6843",
            "fax_number": "856-566-6419"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KEDZIORA",
        "first_name": "HALINA",
        "middle_name": "M",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-01-18",
        "last_updated": "2016-04-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NJ",
            "license": "MA06324100",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7182902",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Stratford, NJ

Sources for this page

Verify at the official NPI Registry.