Provider Demographics
NPI:1528129285
Name:JAWORSKY, VICTOR JOHN (MD)
Entity type:Individual
Prefix:
First Name:VICTOR
Middle Name:JOHN
Last Name:JAWORSKY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 196
Mailing Address - Street 2:NONE
Mailing Address - City:ORANGEBURG
Mailing Address - State:NY
Mailing Address - Zip Code:10962-0196
Mailing Address - Country:US
Mailing Address - Phone:845-359-1000
Mailing Address - Fax:845-680-5590
Practice Address - Street 1:140 OLD ORANGEBURG RD
Practice Address - Street 2:BUILDING #60
Practice Address - City:ORANGEBURG
Practice Address - State:NY
Practice Address - Zip Code:10962-1157
Practice Address - Country:US
Practice Address - Phone:845-359-1000
Practice Address - Fax:845-680-5590
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2007-07-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY1579161207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYF38037Medicare UPIN