Jack Jedwab, M.D.

Primary specialty

Pediatric Urology PhysicianTaxonomy code 2088P0231X

License

139976 Issued in NY

Practice address

2270 Kimball St
Suite 214
Brooklyn, NY 11234-5139

Phone

(718) 377-7575

Fax

(718) 377-8566

NPI assigned

Mar 6, 2007

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NY

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

Specialty

Urology

Education

Other, 1974

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Ahava Medical and Rehabilitation Center, LLCGroup PAC ID 1557416997, 150 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

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.

• Ahava Medical and Rehabilitation Center, LLC

  • Rehabilitation Practitioner
  • Brooklyn, NY
  • NPI 1184878274
  Medicare reassignment Care Compare group NPD
• Jack Jedwab MD PC

  • Urology Physician
  • Brooklyn, NY
  • NPI 1194096404
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1173139200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1427188879",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2270 KIMBALL ST",
            "address_2": "SUITE 214",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112345139",
            "telephone_number": "718-377-7575",
            "fax_number": "718-377-8566"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2270 KIMBALL ST",
            "address_2": "SUITE 214",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112345139",
            "telephone_number": "718-377-7575",
            "fax_number": "718-377-8566"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JEDWAB",
        "first_name": "JACK",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-03-06",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2088P0231X",
            "taxonomy_group": "",
            "desc": "Urology, Pediatric Urology",
            "state": "NY",
            "license": "139976",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00495565",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Tamara Jeanty, RN
• Antoine Jebran, MD
• Linda Jeddah
• Jedidiah Physical Therapy PC
• Agnieska Jednacz, OT
• Andrzej Roman Jedynak, MD, MS
• Jennifer Jee-Roytman, PSYD
• Kanika N Jefferies, LMSW
• Maria Jeffers-Woodley
• Felty Jeffers

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.