Provider Demographics
NPI:1588102370
Name:BARBARA JANECZKODDS,PC
Entity type:Organization
Organization Name:BARBARA JANECZKODDS,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR
Authorized Official - Prefix:DR
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:
Authorized Official - Last Name:JANECZKO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-521-7515
Mailing Address - Street 1:803 GREGORY PL
Mailing Address - Street 2:
Mailing Address - City:RIVERHEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11901-2900
Mailing Address - Country:US
Mailing Address - Phone:631-521-7515
Mailing Address - Fax:631-521-7517
Practice Address - Street 1:803 GREGORY PL
Practice Address - Street 2:
Practice Address - City:RIVERHEAD
Practice Address - State:NY
Practice Address - Zip Code:11901-2900
Practice Address - Country:US
Practice Address - Phone:631-521-7515
Practice Address - Fax:631-521-7517
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-01
Last Update Date:2017-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty