Provider Demographics
NPI:1801063631
Name:OREST PADKOWSKY, MD, LLC
Entity type:Organization
Organization Name:OREST PADKOWSKY, MD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:OREST
Authorized Official - Middle Name:
Authorized Official - Last Name:PADKOWSKY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-823-8555
Mailing Address - Street 1:989 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:BAYONNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07002-4040
Mailing Address - Country:US
Mailing Address - Phone:201-823-8555
Mailing Address - Fax:201-823-2979
Practice Address - Street 1:989 BROADWAY
Practice Address - Street 2:
Practice Address - City:BAYONNE
Practice Address - State:NJ
Practice Address - Zip Code:07002-4040
Practice Address - Country:US
Practice Address - Phone:201-823-8555
Practice Address - Fax:201-823-2979
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-12
Last Update Date:2008-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA42151207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty