Organization Name: | CHARLES F. JURACKA |
NPI Number: | 1023294915 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | CHARLES F JURACKA (OWNER/OPTICIAN) |
Mailing Address: | 604 Union St Schenectady |
State: | NY US |
Postal Code: | 123051503 |
Phone Number: | 5183771283 |
Fax Number: | 5183705058 |
NPI Enumeration Date: | 01/10/2008 |
NPI Last Update Date: | 04/22/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 332BC3200X |
License Number: | C002465-1 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NY |
Taxonomy Type: | Suppliers |
Taxonomy Classification: | Durable Medical Equipment & Medical Supplies |
Taxonomy Specialization: | Customized Equipment |
Taxonomy Definition: |