Provider Demographics
NPI:1346467065
Name:CHRUSCINSKI, ANDRZEJ JAN (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:ANDRZEJ
Middle Name:JAN
Last Name:CHRUSCINSKI
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:675 SHARON PARK DR APT 104
Mailing Address - Street 2:
Mailing Address - City:MENLO PARK
Mailing Address - State:CA
Mailing Address - Zip Code:94025-6907
Mailing Address - Country:US
Mailing Address - Phone:650-387-8748
Mailing Address - Fax:650-618-8744
Practice Address - Street 1:675 SHARON PARK DR APT 104
Practice Address - Street 2:
Practice Address - City:MENLO PARK
Practice Address - State:CA
Practice Address - Zip Code:94025-6907
Practice Address - Country:US
Practice Address - Phone:650-387-8748
Practice Address - Fax:650-618-8744
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA79758207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine