Healthcare Provider Details

I. General information

NPI: 1992981823
Provider Name (Legal Business Name): JACK SKARBINSKI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: JACEK SKARBINSKI

II. Dates (important events)

Enumeration Date: 01/10/2008
Last Update Date: 01/11/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43 ROCK LN
BERKELEY CA
94708-1309
US

IV. Provider business mailing address

43 ROCK LN
BERKELEY CA
94708-1309
US

V. Phone/Fax

Practice location:
  • Phone: 415-572-8437
  • Fax:
Mailing address:
  • Phone: 415-572-8437
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number59202
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number81073
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: