Healthcare Provider Details

I. General information

NPI: 1902038722
Provider Name (Legal Business Name): PIOTR ALEKSANDER JAWOROWSKI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2009
Last Update Date: 08/12/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 NOTT ST
SCHENECTADY NY
12308-2425
US

IV. Provider business mailing address

1462 ERIE BLVD
SCHENECTADY NY
12305-1026
US

V. Phone/Fax

Practice location:
  • Phone: 518-243-4135
  • Fax: 518-243-1367
Mailing address:
  • Phone: 518-243-1020
  • Fax: 518-243-1021

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number254329
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number254329
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: