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General NPI Number Information
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NPI Number | 1922416387
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Entity Type | Individual
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Provider Name | JAN CZEREPAK D.O.
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Gender | Male
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Dates
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Enumeration Date | 07/30/2014
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Last Update Date | 12/12/2023
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Provider Practice Location Address
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Address Line | 2401 PENNSYLVANIA AVE STE B9
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City | PHILADELPHIA
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State | PA
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Zip | 19130-3010
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Country | US
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Telephone | 215-629-1353
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Fax | 866-521-0299
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Provider Business Mailing Address
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Address Line | 325 MOLNAR DR
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City | ELMWOOD PARK
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State | NJ
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Zip | 07407-3207
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207YX0905X
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Taxonomy Name | Otolaryngology/Facial Plastic Surgery Physician
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License Number | 25MB06847100
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 25MB06847100
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License Number State | NJ
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Taxonomy #3
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Taxonomy Code | 204D00000X
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Taxonomy Name | Neuromusculoskeletal Medicine & OMM Physician
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License Number | 25MB06847100
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License Number State | NJ
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