Healthcare Provider Details

I. General information

NPI: 1033148952
Provider Name (Legal Business Name): JAROSLAW CZAJKOWSKI DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/02/2006
Last Update Date: 03/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

329 CHESTNUT ST
ROSELLE PARK NJ
07204-1948
US

IV. Provider business mailing address

329 CHESTNUT ST
ROSELLE PARK NJ
07204-1948
US

V. Phone/Fax

Practice location:
  • Phone: 908-241-4390
  • Fax:
Mailing address:
  • Phone: 908-241-4390
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number40QA00772400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: