MEDICARE: TADEUSZ JEDLINSKI MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	25MA06088900	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1033151469
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TADEUSZ JEDLINSKI MD

Provider Business Mailing Address
First Line	:	50 MT.PROSPECT AVE, STE.202
Second Line	:
City	:	CLIFTON
State	:	NJ
Zip	:	07013
Country	:	US
Telephone Number	:	973-458-0407
Fax Number	:

Provider Business Practice Location Address
First Line	:	50 MOUNT PROSPECT AVE
Second Line	:	STE.202
City	:	CLIFTON
State	:	NJ
Zip	:	07013-1900
Country	:	US
Telephone Number	:	973-458-0407
Fax Number	:	973-458-0889

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/11/2006
Last Update Date	:	10/26/2015

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