Provider Demographics
NPI:1013958818
Name:JADCZAK, JEFFERY (PT)
Entity Type:Individual
Prefix:
First Name:JEFFERY
Middle Name:
Last Name:JADCZAK
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 W 10TH ST
Mailing Address - Street 2:
Mailing Address - City:MARCUS HOOK
Mailing Address - State:PA
Mailing Address - Zip Code:19061-4513
Mailing Address - Country:US
Mailing Address - Phone:610-859-8850
Mailing Address - Fax:610-859-7876
Practice Address - Street 1:8019 FRANKFORD AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19136-2786
Practice Address - Country:US
Practice Address - Phone:215-338-8900
Practice Address - Fax:215-338-8923
Is Sole Proprietor?:No
Enumeration Date:2006-06-10
Last Update Date:2010-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEJ10001754225100000X
PAPT015518225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA30051358OtherKEYSTONE MERCY
PA000000215642OtherAMERICHOICE
P00359632OtherMEDICARE RR
1013958818OtherBRAVO
PA102406483-0001Medicaid
1483149OtherHIGHMARK
PA2173675000OtherIBC
P00359632OtherMEDICARE RR
PA30051358OtherKEYSTONE MERCY
1483149OtherHIGHMARK
PA000000215642OtherAMERICHOICE
P57051Medicare UPIN
DEG02348D11Medicare PIN