Provider Demographics
NPI:1437159878
Name:KABARITI, JACK (MD)
Entity Type:Individual
Prefix:DR
First Name:JACK
Middle Name:
Last Name:KABARITI
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 1:2118 CONEY ISLAND AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11223-2347
Mailing Address - Country:US
Mailing Address - Phone:718-376-1233
Mailing Address - Fax:718-376-0449
Practice Address - Street 1:2118 CONEY ISLAND AVE STE 1
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11223-2347
Practice Address - Country:US
Practice Address - Phone:718-376-1233
Practice Address - Fax:718-376-0449
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-28
Last Update Date:2023-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY223838174400000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0100525-02OtherAMERICHOICE OF NY
NY02245081Medicaid
NY505X71OtherEMPIRE BLUE CROSS
NY0100525-02OtherAMERICHOICE OF NY
NY02245081Medicaid