Provider Demographics
NPI:1164692778
Name:ZINA D. HAJDUCZOK, M.D.P.C.
Entity Type:Organization
Organization Name:ZINA D. HAJDUCZOK, M.D.P.C.
Other - Org Name:DBA LEWISTON CARDIOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:M.D.
Authorized Official - Prefix:
Authorized Official - First Name:ZINA
Authorized Official - Middle Name:D
Authorized Official - Last Name:HAJDUCZOK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:716-296-1686
Mailing Address - Street 1:5320 MILITARY RD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:LEWISTON
Mailing Address - State:NY
Mailing Address - Zip Code:14092-2149
Mailing Address - Country:US
Mailing Address - Phone:716-297-1686
Mailing Address - Fax:716-297-1706
Practice Address - Street 1:5320 MILITARY RD
Practice Address - Street 2:SUITE 105
Practice Address - City:LEWISTON
Practice Address - State:NY
Practice Address - Zip Code:14092-2149
Practice Address - Country:US
Practice Address - Phone:716-297-1686
Practice Address - Fax:716-297-1706
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-11
Last Update Date:2008-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY164649207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01250357Medicaid
NYAA1446Medicare PIN