Provider Demographics
NPI:1083091789
Name:DZIEWA, IWONA (DO)
Entity Type:Individual
Prefix:
First Name:IWONA
Middle Name:
Last Name:DZIEWA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6026 80TH AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11385-6048
Mailing Address - Country:US
Mailing Address - Phone:347-612-6018
Mailing Address - Fax:
Practice Address - Street 1:3680 HILL BLVD
Practice Address - Street 2:
Practice Address - City:JEFFERSON VALLEY
Practice Address - State:NY
Practice Address - Zip Code:10535-1500
Practice Address - Country:US
Practice Address - Phone:914-245-7700
Practice Address - Fax:914-248-2081
Is Sole Proprietor?:No
Enumeration Date:2015-05-01
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS021208207K00000X
NY309855207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology