Provider Demographics
NPI:1891959466
Name:JEDYNAK, ANDRZEJ ROMAN (MD, MS)
Entity Type:Individual
Prefix:DR
First Name:ANDRZEJ
Middle Name:ROMAN
Last Name:JEDYNAK
Suffix:
Gender:M
Credentials:MD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 EXCHANGE PL UNIT 14
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07302-4932
Mailing Address - Country:US
Mailing Address - Phone:201-830-3200
Mailing Address - Fax:
Practice Address - Street 1:339 HICKS ST
Practice Address - Street 2:RADIOLOGY DEPT
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-5509
Practice Address - Country:US
Practice Address - Phone:718-780-1788
Practice Address - Fax:718-780-4922
Is Sole Proprietor?:No
Enumeration Date:2008-07-14
Last Update Date:2010-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NY2594172085R0202X
CT0488572085R0202X
NJ25MA083610002085R0202X
WI53067-0202085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program