Physician Compare National (NPI:1962474502)

HEALTHCARE PROVIDER: JACK KANAREK M.D.

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1962474502
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	4789769472
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20080305000188
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	KANAREK
	Individual professional last name
Provider First Name	JACK
	Individual professional first name
Provider Middle Name	I
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	ALBERT EINSTEIN COLLEGE OF MEDICINE OF YESHIVA UNIVERSITY
	Individual professional's medical school
Graduation Year	1992
	Individual professional's medical school graduation year
Primary Specialty	OBSTETRICS/GYNECOLOGY
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	6905 YELLOWSTONE BLVD
	Group Practice or individual's line 1 address
City	FOREST HILLS
	Group Practice or individual's city
State	NY
	Group Practice or individual's state
Zip Code	113753753
	Group Practice or individual's zip code (9 digits when available)
Phone Number	7185448400
	Phone number is listed only when there is a single phone number available for the practice location address

Hospital(s) Affiliation Information
Professional Accepts Medicare Assignment	Y