Provider Demographics
NPI:1669417382
Name:PULKRABEK, JANA (MD)
Entity type:Individual
Prefix:
First Name:JANA
Middle Name:
Last Name:PULKRABEK
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 1:722 W WATER ST
Mailing Address - Street 2:
Mailing Address - City:ELMIRA
Mailing Address - State:NY
Mailing Address - Zip Code:14905-2435
Mailing Address - Country:US
Mailing Address - Phone:607-271-2050
Mailing Address - Fax:607-271-2099
Practice Address - Street 1:8 DENISON PKWY E
Practice Address - Street 2:
Practice Address - City:CORNING
Practice Address - State:NY
Practice Address - Zip Code:14830-2638
Practice Address - Country:US
Practice Address - Phone:607-936-4143
Practice Address - Fax:607-936-6836
Is Sole Proprietor?:No
Enumeration Date:2006-06-17
Last Update Date:2014-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY153671-1207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00785117Medicaid
P00247210Medicare ID - Type UnspecifiedRAILROAD MEDICARE NUMBER
NYJ400066902Medicare PIN
B82354Medicare UPIN