Provider Demographics
NPI:1154490480
Name:DUDZINSKI ENTERPRISES, INC.
Entity Type:Organization
Organization Name:DUDZINSKI ENTERPRISES, INC.
Other - Org Name:NORTH EAST FAMILY PRACTICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:E
Authorized Official - Last Name:DUDZINSKI
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:814-725-8774
Mailing Address - Street 1:115 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NORTH EAST
Mailing Address - State:PA
Mailing Address - Zip Code:16428-1330
Mailing Address - Country:US
Mailing Address - Phone:814-725-8774
Mailing Address - Fax:814-725-2391
Practice Address - Street 1:115 E MAIN ST
Practice Address - Street 2:
Practice Address - City:NORTH EAST
Practice Address - State:PA
Practice Address - Zip Code:16428-1330
Practice Address - Country:US
Practice Address - Phone:814-725-8774
Practice Address - Fax:814-725-2391
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-08
Last Update Date:2008-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS006274L207Q00000X
PAOS012532207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1014723860001Medicaid
PA097617Medicare ID - Type Unspecified