1992883011 NPI number — DR. RYSZARD JERZY CHETKOWSKI M.D.

Table of content: DR. RYSZARD JERZY CHETKOWSKI M.D. (NPI 1992883011)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992883011 NPI number — DR. RYSZARD JERZY CHETKOWSKI M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CHETKOWSKI
Provider First Name:
RYSZARD
Provider Middle Name:
JERZY
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CHETKOWSKI
Provider Other First Name:
RICHARD
Provider Other Middle Name:
JERZY
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1992883011
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2999 REGENT ST STE 101-A
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BERKELEY
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94705-2116
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
510-649-0440
Provider Business Mailing Address Fax Number:
510-649-8700

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2999 REGENT ST STE 101-A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BERKELEY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94705-2116
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-649-0440
Provider Business Practice Location Address Fax Number:
510-649-8700
Provider Enumeration Date:
11/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207VE0102X , with the licence number:  G47258 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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