Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207T00000X | Neurosurgeon | OS14529 | FL |
NPI | 1053610808 |
---|---|
Provider Name | Dr. Jacob Januszewski |
First Address | Melbourne, FL 32901-5591 |
Second Address | Melbourne, FL 32901-5591 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/03/2011 |
Last Update Date | 21/01/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
021089200 | (05) | FL |
1143045 | CAREPLUS (01) | FL |
1531493 | WELLCARE (01) | FL |
4762182 | AETNA (01) | FL |
9076362 | CIGNA (01) | FL |
W9TNA | FLORIDA BLUE (01) | FL |