MEDICARE: DR. JERZY WAWERSKI 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	207R00000X	Internal Medicine Physician	204587	NY

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	:	1922087758
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JERZY WAWERSKI MD

Provider Business Mailing Address
First Line	:	9001 3RD AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11209-5707
Country	:	US
Telephone Number	:	718-748-2900
Fax Number	:	718-748-9365

Provider Business Practice Location Address
First Line	:	1029 MANHATTAN AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11222-5840
Country	:	US
Telephone Number	:	718-383-3377
Fax Number	:	718-383-3606

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

Provider Enumeration Date	:	01/11/2006
Last Update Date	:	07/08/2007

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