Provider Demographics
NPI:1104010131
Name:JAWETZ, SETH GERALD (MD)
Entity Type:Individual
Prefix:DR
First Name:SETH
Middle Name:GERALD
Last Name:JAWETZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6 BRIGHTON ROAD
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07012-1647
Mailing Address - Country:US
Mailing Address - Phone:973-777-7911
Mailing Address - Fax:973-473-5958
Practice Address - Street 1:6 BRIGHTON ROAD
Practice Address - Street 2:2ND FLOOR
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07012-1647
Practice Address - Country:US
Practice Address - Phone:973-777-7911
Practice Address - Fax:973-777-5403
Is Sole Proprietor?:No
Enumeration Date:2007-09-03
Last Update Date:2019-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08536200207RC0000X
NY233546207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ155336Medicare PIN