Provider Demographics
NPI:1215494927
Name:FIALKOFF, JARED
Entity type:Individual
Prefix:
First Name:JARED
Middle Name:
Last Name:FIALKOFF
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:145 ROSEMARY ST STE C1
Mailing Address - Street 2:
Mailing Address - City:NEEDHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02494-3259
Mailing Address - Country:US
Mailing Address - Phone:781-433-2110
Mailing Address - Fax:
Practice Address - Street 1:145 ROSEMARY ST STE C1
Practice Address - Street 2:
Practice Address - City:NEEDHAM
Practice Address - State:MA
Practice Address - Zip Code:02494-3259
Practice Address - Country:US
Practice Address - Phone:781-433-2110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-28
Last Update Date:2024-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1017523208800000X
IL036158482208800000X
IL125073537208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology