Healthcare Provider Details

I. General information

NPI: 1720061070
Provider Name (Legal Business Name): TADEUSZ JANUSZ MAJCHRZAK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/21/2005
Last Update Date: 05/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 KENNEDY BLVD STE 308
JERSEY CITY NJ
07306-3817
US

IV. Provider business mailing address

PO BOX 8329
JERSEY CITY NJ
07308-8329
US

V. Phone/Fax

Practice location:
  • Phone: 201-963-0800
  • Fax: 201-656-6934
Mailing address:
  • Phone: 201-963-0800
  • Fax: 201-656-6934

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMA5867500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: