Provider Demographics
NPI:1033151469
Name:JEDLINSKI, TADEUSZ (MD)
Entity Type:Individual
Prefix:
First Name:TADEUSZ
Middle Name:
Last Name:JEDLINSKI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 MT.PROSPECT AVE, STE.202
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07013
Mailing Address - Country:US
Mailing Address - Phone:973-458-0407
Mailing Address - Fax:
Practice Address - Street 1:50 MOUNT PROSPECT AVE
Practice Address - Street 2:STE.202
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07013-1900
Practice Address - Country:US
Practice Address - Phone:973-458-0407
Practice Address - Fax:973-458-0889
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-11
Last Update Date:2015-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06088900208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ624-5005Medicaid