Provider Demographics
NPI:1073628244
Name:JAJKOWSKI, MARK ROBERT (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:ROBERT
Last Name:JAJKOWSKI
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:515 ABBOTT RD
Mailing Address - Street 2:STE 310
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14220-1700
Mailing Address - Country:US
Mailing Address - Phone:716-332-3505
Mailing Address - Fax:716-332-3509
Practice Address - Street 1:2695 HARLEM RD
Practice Address - Street 2:
Practice Address - City:CHEEKTOWAGA
Practice Address - State:NY
Practice Address - Zip Code:14225-4021
Practice Address - Country:US
Practice Address - Phone:716-332-3505
Practice Address - Fax:716-332-3509
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2018-12-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY210052208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000527369001OtherBLUE CROSS/BLUE SHIELD
NY010549324OtherGHI
NY00026371301OtherUNIVERA
NY040426002783OtherFIDELIS
NY010549324OtherEMPIRE UNITED HEALTHCARE
NY1811716OtherINDEPENDENT HEALTH
NY02414840Medicaid