Provider Demographics
NPI:1790722049
Name:JEDRYCHOWSKI, JERZY STANISLAW (MD)
Entity Type:Individual
Prefix:DR
First Name:JERZY
Middle Name:STANISLAW
Last Name:JEDRYCHOWSKI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:12 ESSEX CT
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06032-1433
Mailing Address - Country:US
Mailing Address - Phone:860-677-8996
Mailing Address - Fax:
Practice Address - Street 1:33 LEXINGTON ST
Practice Address - Street 2:
Practice Address - City:NEW BRITAIN
Practice Address - State:CT
Practice Address - Zip Code:06052-1446
Practice Address - Country:US
Practice Address - Phone:860-225-7007
Practice Address - Fax:860-826-5307
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT025602207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTE52440Medicare UPIN