Provider Demographics
NPI:1790803302
Name:MICHAEL A JALOWIEC DO PC
Entity Type:Organization
Organization Name:MICHAEL A JALOWIEC DO PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JOHNNA
Authorized Official - Middle Name:
Authorized Official - Last Name:JALOWIEC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-851-9618
Mailing Address - Street 1:821 S MAIN ST
Mailing Address - Street 2:SUITE 4
Mailing Address - City:OLD FORGE
Mailing Address - State:PA
Mailing Address - Zip Code:18518-1497
Mailing Address - Country:US
Mailing Address - Phone:570-457-2300
Mailing Address - Fax:570-457-6627
Practice Address - Street 1:821 S MAIN ST
Practice Address - Street 2:SUITE 4
Practice Address - City:OLD FORGE
Practice Address - State:PA
Practice Address - Zip Code:18518-1431
Practice Address - Country:US
Practice Address - Phone:570-457-2300
Practice Address - Fax:570-457-6627
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2023-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS007959L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0015121390005Medicaid
PA111800Medicare PIN
PA0015121390005Medicaid