Provider Demographics
NPI:1376765198
Name:SYPEK, TADEUSZ M (MD)
Entity Type:Individual
Prefix:DR
First Name:TADEUSZ
Middle Name:M
Last Name:SYPEK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:TED
Other - Middle Name:M
Other - Last Name:SYPEK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:32 IRIS CIRCLE
Mailing Address - Street 2:
Mailing Address - City:BEACON
Mailing Address - State:NY
Mailing Address - Zip Code:12508
Mailing Address - Country:US
Mailing Address - Phone:845-876-2011
Mailing Address - Fax:845-876-7119
Practice Address - Street 1:21 FERNCLIFF DRIVE
Practice Address - Street 2:
Practice Address - City:RHINEBECK
Practice Address - State:NY
Practice Address - Zip Code:12572-1900
Practice Address - Country:US
Practice Address - Phone:845-876-2011
Practice Address - Fax:845-876-7119
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY106172-1208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00532247Medicaid
NYB16820Medicare UPIN
NY576051Medicare ID - Type Unspecified