Provider Demographics
NPI:1780625079
Name:JAROSZ, JOHN RAYMOND JR (DC)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:RAYMOND
Last Name:JAROSZ
Suffix:JR
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:143 N WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:NY
Mailing Address - Zip Code:13440-5805
Mailing Address - Country:US
Mailing Address - Phone:315-339-2422
Mailing Address - Fax:315-733-5024
Practice Address - Street 1:143 N WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:NY
Practice Address - Zip Code:13440-5805
Practice Address - Country:US
Practice Address - Phone:315-339-2422
Practice Address - Fax:315-733-5024
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2016-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX011243111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYC11243-5WOtherWCOMP
NYP010011243OtherBCBS
NYP010011243OtherBCBS
NYRB3043Medicare PIN