Individual
KATHRYN ELIZABETH WITCZAK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1825 RTE 35, WALL TOWNSHIP, NJ 07719-3541
(732) 280-2600
(848) 469-8933
Mailing address
1216 TAYLOR LN, FORKED RIVER, NJ 08731-4540
(862) 222-4285
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
25MP00420800
NJ
363AM0700X
Medical Physician Assistant
Primary
25MP00420800
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0542474
—
NJ
Enumeration date
12/14/2016
Last updated
01/23/2023
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