Provider Demographics
NPI:1770690208
Name:KACZOROWSKI, PATRICIA M (PA C)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:M
Last Name:KACZOROWSKI
Suffix:
Gender:F
Credentials:PA C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:355 GRAND ST
Mailing Address - Street 2:EMERGENCY DEPARTMENT-JERSEY CITY MEDICAL CENTER
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07302-4321
Mailing Address - Country:US
Mailing Address - Phone:201-915-2200
Mailing Address - Fax:201-714-7908
Practice Address - Street 1:355 GRAND ST
Practice Address - Street 2:EMERGENCY DEPARTMENT-JERSEY CITY MEDICAL CENTER
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07302-4321
Practice Address - Country:US
Practice Address - Phone:201-915-2200
Practice Address - Fax:201-714-7908
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2008-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00002700363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00415908Medicare PIN
NJ097882DBMMedicare PIN