STEPHEN J JACKOWSKI RPA NPI 1215990536

NPI Information

NPI: 1215990536
Provider Name: STEPHEN J JACKOWSKI, RPA
Classification: Physician Assistant - 363AM0700X
Entity Type: Individual

Specialization: Medical

PECOS Registration: Yes

Address:
4103 MEDICAL CENTER DR
FAYETTEVILLE, NY
ZIP 13066
Phone: (315) 637-7800
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Stephen J Jackowski, RPA is a medical physician assistant in Fayetteville, NY with 32 years of experience. Stephen J Jackowski, RPA NPI is 1215990536. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

Education
Medical School: ALBANY MEDICAL COLLEGE OF UNION UNIVERSITY
Graduation Year:1992

The provider's business location address is:

4103 MEDICAL CENTER DR
FAYETTEVILLE, NY
ZIP 13066-600
Phone: (315) 637-7800
Fax: (315) 637-7808

The NPI 1215990536 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 4/8/2006 and was last updated on 11/15/2011.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	363AM0700X	Physician Assistant	Medical	004417	NEW YORK	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State
1	02144989	MEDICAID	NEW YORK
2	R888604	MEDICARE UPIN	NEW YORK
3	J400040765	MEDICARE PIN	NEW YORK
4	PA0365	MEDICARE ID-TYPE UNSPECIFIED	NEW YORK

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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