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Organization

FOREST MEDCARE P.C.

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. JERZY WAWERSKI M.D. (MEDICAL DOCTOR)
(718) 381-3766
Entity
Organization

Contact information

Practice address
6050 69TH AVE, GROUND FLOOR, RIDGEWOOD, NY 11385-5140
(718) 381-3766
(718) 381-3765
Mailing address
6657 FOREST AVE, GROUND FLOOR, RIDGEWOOD, NY 11385-3837
(718) 381-3766
(718) 381-3765

Taxonomy

Speciality
Code
Description
License number
State
173000000X
Legal Medicine
Primary
204587
NY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
02131684
NY
01
06979A
MEDICARE PTAN
NY
Enumeration date
11/10/2006
Last updated
06/13/2008
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