Provider Demographics
NPI:1497752653
Name:JAROWSKI, CHARLES I (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:I
Last Name:JAROWSKI
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 1:400 E 77TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10075-2303
Mailing Address - Country:US
Mailing Address - Phone:212-794-9500
Mailing Address - Fax:212-734-8350
Practice Address - Street 1:400 E 77TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10075-2303
Practice Address - Country:US
Practice Address - Phone:212-794-9500
Practice Address - Fax:212-734-8350
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-02
Last Update Date:2007-07-23
Deactivation Date:2006-03-20
Deactivation Code:
Reactivation Date:2006-03-27
Provider Licenses
StateLicense IDTaxonomies
NY116780207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00299674Medicaid
NYNS4435OtherOXFORD HEALTH CARE
1329865860001OtherCIGNA
0C1334OtherHEATH NET
NYB12431Medicare UPIN
NY00299674Medicaid
CJ02941010Medicare PIN