Healthcare Provider Details

I. General information

NPI: 1528050259
Provider Name (Legal Business Name): JENNIFER C CZARNIAK PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2005
Last Update Date: 09/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

725 ALBANY ST SHAPIRO 8, SUITE A
BOSTON MA
02118
US

IV. Provider business mailing address

16 BOXBERRY LN UNIT 16
ROCKLAND MA
02370-1103
US

V. Phone/Fax

Practice location:
  • Phone: 617-638-8419
  • Fax: 617-414-0201
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number1100
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: