Jack Jedwab MD PC

Primary specialty

Urology PhysicianTaxonomy code 208800000X

License

139976 Issued in NY

Legal business name

JACK JEDWAB MD PC

Practice address

2270 Kimball St
Brooklyn, NY 11234-5139

Phone

(718) 377-7575

NPI assigned

Jan 18, 2012

Organization subpart

No

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

Authorized official

Name

Dr. Jack Jedwab, MDNPI 1427188879

Title

President

Phone

(718) 377-7575

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NY

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Jack Jedwab, M.D.

  • Pediatric Urology Physician
  • Brooklyn, NY
  • NPI 1427188879
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1326844800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1326844800000",
    "number": "1194096404",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2270 KIMBALL ST",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112345139",
            "telephone_number": "718-377-7575"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2270 KIMBALL ST",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112345139",
            "telephone_number": "718-377-7575"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACK JEDWAB MD PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-01-18",
        "last_updated": "2012-01-18",
        "status": "A",
        "authorized_official_last_name": "JEDWAB",
        "authorized_official_first_name": "JACK",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "718-377-7575",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Urology",
            "state": "NY",
            "license": "139976",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Peggy Jacilien
• Jose Maria Roberto Cruz Jacinto, MD
• Jack Fatiha MD PC
• Jack Husney MD P.C.
• Jack I. Apelbaum, M.D., P.L.L.C.
• Gail Jack-Mason
• Lystra Jack-Tosssaint, LPN
• Gweneth Kaycita Jack
• Kelvin Karibo Jack, M.D
• Lesleen A Jack

• Urology Physician in Brooklyn, NY
• Providers in Brooklyn, NY by specialty
• Urology Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 18, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.