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General NPI Number Information
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NPI Number | 1023294915
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Entity Type | Organization
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Legal Business Name | CHARLES F. JURACKA
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Dates
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Enumeration Date | 01/10/2008
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Last Update Date | 04/22/2008
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Provider Practice Location Address
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Address Line | 604 UNION ST
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City | SCHENECTADY
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State | NY
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Zip | 12305-1503
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Country | US
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Telephone | 518-377-1283
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Fax | 518-370-5058
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Provider Business Mailing Address
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Address Line | 604 UNION ST
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City | SCHENECTADY
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State | NY
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Zip | 12305-1503
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Country | US
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Telephone | 518-377-1283
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Fax | 518-370-5058
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Authorized Official
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Title or Position | OWNER/OPTICIAN
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Name | MR. CHARLES F JURACKA
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Credential | OPTICIAN
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Telephone | 518-377-1283
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BC3200X
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Taxonomy Name | Customized Equipment (DME)
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License Number | C002465-1
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License Number State | NY
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