Provider Demographics
NPI:1619063963
Name:DWORKIN, JACK HARVEY (MD,FACC)
Entity Type:Individual
Prefix:DR
First Name:JACK
Middle Name:HARVEY
Last Name:DWORKIN
Suffix:
Gender:M
Credentials:MD,FACC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:146 US HIGHWAY 9
Mailing Address - Street 2:SUITE B
Mailing Address - City:ENGLISHTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07726-8249
Mailing Address - Country:US
Mailing Address - Phone:732-972-1151
Mailing Address - Fax:732-972-9492
Practice Address - Street 1:146 US HIGHWAY 9
Practice Address - Street 2:SUITE B
Practice Address - City:ENGLISHTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07726-8249
Practice Address - Country:US
Practice Address - Phone:732-972-1151
Practice Address - Fax:732-972-9492
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA04348800207RC0000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0384003Medicaid
NJMS021OtherOXFORD
NH0099090000OtherAMERIHEALTH
NH0040678OtherAETNA
NJ0077109OtherGHI
NJ060005317OtherMEDICARE RAILROAD