Provider Demographics
NPI:1932383577
Name:ADAM J JARCZEWSKI MEDICAL DOCTOR INC
Entity Type:Organization
Organization Name:ADAM J JARCZEWSKI MEDICAL DOCTOR INC
Other - Org Name:BEYONDSTABLE PSYCHIATRY & INTEGRATIVE CARE
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:J
Authorized Official - Last Name:JARCZEWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:650-521-6014
Mailing Address - Street 1:2055 WOODSIDE RD.,
Mailing Address - Street 2:SUITE 155
Mailing Address - City:REDWOOD CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94061-3355
Mailing Address - Country:US
Mailing Address - Phone:650-364-4200
Mailing Address - Fax:650-364-4210
Practice Address - Street 1:2055 WOODSIDE RD.,
Practice Address - Street 2:SUITE 155
Practice Address - City:REDWOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94061-3355
Practice Address - Country:US
Practice Address - Phone:650-364-4200
Practice Address - Fax:650-364-4210
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-18
Last Update Date:2010-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA82540261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAI 14057Medicare UPIN