Jan Idzikowski, PA

Primary specialty

Surgical Physician AssistantTaxonomy code 363AS0400X

License

1188 Issued in NH

Practice address

273 County Rd
New London, NH 03257-5736

Phone

(603) 526-2911

NPI assigned

Jun 24, 2005

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: jidzikowski383192@direct.dartmouth-hitchcock.org

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.

• The New London Hospital Association, Inc.

  • Multi-Specialty Clinic/Center
  • Newport, NH
  • NPI 1770684672
  NPD (past)

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

{
    "created_epoch": "1119571200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1578441600000",
    "number": "1629074505",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "273 COUNTY RD",
            "city": "NEW LONDON",
            "state": "NH",
            "postal_code": "032575736"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "273 COUNTY RD",
            "city": "NEW LONDON",
            "state": "NH",
            "postal_code": "032575736",
            "telephone_number": "603-526-2911"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "IDZIKOWSKI",
        "first_name": "JAN",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-24",
        "last_updated": "2020-01-08",
        "certification_date": "2020-01-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "CO",
            "license": "585",
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "NH",
            "license": "1188",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "42889057",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jennifer Elizabeth Hollis
• Hope Elizabeth Damon R.D.,C.D.E., L.D.
• Mary Margaret Horan, MSW, LICSW
• Linda Howes, CN
• Brenna P Humphrey
• Lucia Guadalupe Jarrell, LMFT & LMHC
• Lawrence Richard Jenkyn, M.D.
• Eva H Johnson, MLADC
• Elizabeth Ann Johnston, LICSW
• Stephen Jordan, MD

• Surgical Physician Assistant in New London, NH
• Providers in New London, NH by specialty
• Surgical Physician Assistant in New Hampshire

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 8, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.