Provider Demographics
NPI:1497889638
Name:PAWLECKI, JEFFREY BRENT (MD)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:BRENT
Last Name:PAWLECKI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:J.
Other - Middle Name:BRENT
Other - Last Name:PAWLECKI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:200 E 32ND ST
Mailing Address - Street 2:#15A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-6306
Mailing Address - Country:US
Mailing Address - Phone:212-889-3045
Mailing Address - Fax:
Practice Address - Street 1:1 ELMCROFT RD
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06926-0700
Practice Address - Country:US
Practice Address - Phone:203-351-6434
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT032188207R00000X
NY196778207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
F74428Medicare UPIN