Provider Demographics
NPI:1639242316
Name:JACHIMOWICZ, ARKADIUSZ AREK (DPM)
Entity Type:Individual
Prefix:
First Name:ARKADIUSZ
Middle Name:AREK
Last Name:JACHIMOWICZ
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:87 INDIA ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11222-5910
Mailing Address - Country:US
Mailing Address - Phone:718-389-6755
Mailing Address - Fax:718-389-6755
Practice Address - Street 1:250 E HOUSTON ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10002-1034
Practice Address - Country:US
Practice Address - Phone:718-389-6755
Practice Address - Fax:718-389-6755
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-17
Last Update Date:2013-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
N0055813174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02299163Medicaid
PG3931Medicare ID - Type Unspecified
NY02299163Medicaid