Provider Demographics
NPI:1780953810
Name:JAWORSKI, JANUSZ (LMT)
Entity type:Individual
Prefix:MR
First Name:JANUSZ
Middle Name:
Last Name:JAWORSKI
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7062
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10116-7062
Mailing Address - Country:US
Mailing Address - Phone:917-547-6772
Mailing Address - Fax:
Practice Address - Street 1:125 W 43RD ST
Practice Address - Street 2:SUITE 5A
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10036-6505
Practice Address - Country:US
Practice Address - Phone:917-547-6772
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-19
Last Update Date:2011-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY025213225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist