Healthcare Provider Details

I. General information

NPI: 1083074983
Provider Name (Legal Business Name): MR. JACOB LEW WARSZAWSKI JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/04/2016
Last Update Date: 03/07/2019
Certification Date:
Deactivation Date: 02/21/2019
Reactivation Date: 03/01/2019

III. Provider practice location address

68 W CHURCH ST
NEWARK OH
43055-5050
US

IV. Provider business mailing address

68 W CHURCH ST
NEWARK OH
43055-5050
US

V. Phone/Fax

Practice location:
  • Phone: 740-281-1777
  • Fax:
Mailing address:
  • Phone: 740-281-1777
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: