Provider Demographics
NPI:1912161969
Name:JADOFSKY, MARK S (PO1)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:S
Last Name:JADOFSKY
Suffix:
Gender:M
Credentials:PO1
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 MOHEGAN AVE
Mailing Address - Street 2:USCG ACADEMY
Mailing Address - City:NEW LONDON
Mailing Address - State:CT
Mailing Address - Zip Code:06320
Mailing Address - Country:US
Mailing Address - Phone:860-444-8402
Mailing Address - Fax:
Practice Address - Street 1:15 MOHEGAN AVE
Practice Address - Street 2:U.S. CAOST GUARD ACADEMY
Practice Address - City:NEW LONDON
Practice Address - State:CT
Practice Address - Zip Code:06320-0052
Practice Address - Country:US
Practice Address - Phone:860-444-8402
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-17
Last Update Date:2008-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other