Individual
DR. JACK JEDWAB
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2270 KIMBALL ST, SUITE 214, BROOKLYN, NY 11234-5139
(718) 377-7575
(718) 377-8566
Mailing address
2270 KIMBALL ST, SUITE 214, BROOKLYN, NY 11234-5139
(718) 377-7575
(718) 377-8566
Taxonomy
Speciality
Code
Description
License number
State
2088P0231X
Pediatric Urology Physician
Primary
139976
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00495565
—
NY
Enumeration date
03/06/2007
Last updated
07/08/2007
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