Provider Demographics
NPI:1356320048
Name:JASTRZEBSKI, GEORGE BRINNIG (MD)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:BRINNIG
Last Name:JASTRZEBSKI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:GEORGE
Other - Middle Name:
Other - Last Name:BRINNIG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1360 E VENICE AVE
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34285-9066
Mailing Address - Country:US
Mailing Address - Phone:941-480-2135
Mailing Address - Fax:941-484-2200
Practice Address - Street 1:700 NEAPOLITAN WAY
Practice Address - Street 2:MONTGOMERY EYE CENTER
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34103-8570
Practice Address - Country:US
Practice Address - Phone:239-261-8383
Practice Address - Fax:239-261-8443
Is Sole Proprietor?:No
Enumeration Date:2006-01-11
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT045360207W00000X
FLME 124499207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
4221675OtherAETNA/US HEALTHCARE
A36482OtherMEDICARE B
J27482OtherBLUE SHIELD HMO BLUE
MA2035031Medicaid
4221675OtherAETNA/US HEALTHCARE
MA2035031Medicaid
67933OtherFALLON COMMUNITY HEALTH P
042472266OtherTHREE RIVERS
0801287OtherEVERCARE
61768OtherHEALTHY START
784000OtherMVP HEALTH CARE
A36482OtherMEDICARE B
J27482OtherBLUE SHIELD HMO BLUE
042472266OtherONE HEALTH PLAN
2035031OtherMEDICAID/WELFARE
61768OtherCHILDRENS MEDICAL SECURIT
AA17553OtherHARVARD PILGRIM HEALTHCAR
J27482OtherBLUE SHIELD INDEMNITY
J27482OtherBLUE CARE ELECT