Provider Demographics
NPI:1932401205
Name:CHRISTOPHER JAKUBOWSKI MD LLC
Entity Type:Organization
Organization Name:CHRISTOPHER JAKUBOWSKI MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KRZYSZTOF
Authorized Official - Middle Name:
Authorized Official - Last Name:JAKUBOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-630-9722
Mailing Address - Street 1:244 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MERIDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06451-5149
Mailing Address - Country:US
Mailing Address - Phone:203-630-9722
Mailing Address - Fax:203-630-9725
Practice Address - Street 1:244 MAIN ST
Practice Address - Street 2:
Practice Address - City:MERIDEN
Practice Address - State:CT
Practice Address - Zip Code:06451-5149
Practice Address - Country:US
Practice Address - Phone:203-630-9722
Practice Address - Fax:203-630-9725
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-18
Last Update Date:2010-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT036481261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care