1538190335 NPI number — DR. ANTONI JOHN JURKIEWICZ M.D.

Table of content: DR. ANTONI JOHN JURKIEWICZ M.D. (NPI 1538190335)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538190335 NPI number — DR. ANTONI JOHN JURKIEWICZ M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JURKIEWICZ
Provider First Name:
ANTONI
Provider Middle Name:
JOHN
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:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1538190335
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/18/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
62 BROWN ST STE 203
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HAVERHILL
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01830-6790
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
978-372-7202
Provider Business Mailing Address Fax Number:
978-372-6059

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
62 BROWN ST STE 203
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HAVERHILL
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01830-6790
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
978-372-7202
Provider Business Practice Location Address Fax Number:
978-372-6059
Provider Enumeration Date:
07/06/2006

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: 208600000X , with the licence number:  215106 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 01Y005348MAO1 . This is a "BCBS/ANTHEM" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 020052367 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 450482175 . This is a "HEALTH CARE VALUE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 4750452 . This is a "CIGNA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 28K671 . This is a "EMPIRE BCBS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: J25127 . This is a "BCBS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 17-01344 . This is a "EVERCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: HMO-2293444 . This is a "AETNA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 45-0482175 . This is a "WOMENS HEALTH NETWORK" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 450482175 . This is a "GIC IDEMITY/UNKARE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 043170237 . This is a "TRICARE/CHAMPLD" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 450482175 . This is a "PHCS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 802376 . This is a "HARVARD PILGRIM" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: PPO-4624394 . This is a "AETNA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 9721011 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0027487 . This is a "NHP" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 45-0482175 . This is a "UNITED H.C." identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 795038 . This is a "TUFTS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 973294 . This is a "NETWORK HEALTH" identifier . This identifiers is of the category "OTHER".




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