Provider Demographics
NPI:1356314058
Name:PODZIMEK, JANA (DO)
Entity Type:Individual
Prefix:MS
First Name:JANA
Middle Name:
Last Name:PODZIMEK
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 1:77 NELSON ST STE 130
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:NY
Mailing Address - Zip Code:13021-1941
Mailing Address - Country:US
Mailing Address - Phone:315-255-3300
Mailing Address - Fax:
Practice Address - Street 1:77 NELSON ST STE 130
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:NY
Practice Address - Zip Code:13021-1941
Practice Address - Country:US
Practice Address - Phone:315-255-3300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-12
Last Update Date:2022-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-078953207YX0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0007XAllopathic & Osteopathic PhysiciansOtolaryngologyPlastic Surgery within the Head & Neck
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYJ400099519Medicare PIN
ILIL0101OtherJOHN DEERE
IL212310Medicare ID - Type UnspecifiedGROUP PROVIDER NUMBER
ILE19083Medicare UPIN
ILK20996Medicare PIN