Individual
JARED DITKOWSKY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
30 PROSPECT AVE, HACKENSACK, NJ 07601-1915
(551) 996-3614
Mailing address
3600 ROUTE 66, FL 3, NEPTUNE, NJ 07753-2645
(732) 807-0877
(201) 751-1680
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
25MA11037600
NJ
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/27/2017
Last updated
05/12/2021
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