Provider Demographics
NPI:1194714055
Name:JAN F BABISZEWSKI MD INC
Entity type:Organization
Organization Name:JAN F BABISZEWSKI MD INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CORP PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JAN
Authorized Official - Middle Name:FELIX
Authorized Official - Last Name:BABISZEWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:530-671-4852
Mailing Address - Street 1:874 PLUMAS ST
Mailing Address - Street 2:STE B
Mailing Address - City:YUBA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95991-4023
Mailing Address - Country:US
Mailing Address - Phone:530-671-4852
Mailing Address - Fax:530-671-5752
Practice Address - Street 1:874 PLUMAS ST
Practice Address - Street 2:STE B
Practice Address - City:YUBA CITY
Practice Address - State:CA
Practice Address - Zip Code:95991-4023
Practice Address - Country:US
Practice Address - Phone:530-671-4852
Practice Address - Fax:530-671-5752
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-13
Last Update Date:2008-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC41648208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C416480Medicaid
A37649Medicare UPIN
CA00C416480Medicaid