Provider Demographics
NPI:1245449412
Name:JANKOWIAK, JANET LOUISE (MD)
Entity type:Individual
Prefix:
First Name:JANET
Middle Name:LOUISE
Last Name:JANKOWIAK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 LARKSPUR RD
Mailing Address - Street 2:
Mailing Address - City:NEEDHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02492-3235
Mailing Address - Country:US
Mailing Address - Phone:617-989-8238
Mailing Address - Fax:617-989-8230
Practice Address - Street 1:59 TOWNSEND ST
Practice Address - Street 2:
Practice Address - City:ROXBURY
Practice Address - State:MA
Practice Address - Zip Code:02119-1318
Practice Address - Country:US
Practice Address - Phone:617-989-8238
Practice Address - Fax:617-989-8230
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA707102084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3089207Medicaid
A20077Medicare ID - Type Unspecified
G03962Medicare UPIN