Provider Demographics
NPI:1437219433
Name:DIANA ONDREJIK, MDPLLC
Entity Type:Organization
Organization Name:DIANA ONDREJIK, MDPLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:ONDREJIK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:845-561-5220
Mailing Address - Street 1:10 LITTLE BRITAIN RD STE 103
Mailing Address - Street 2:
Mailing Address - City:NEWBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12550-5161
Mailing Address - Country:US
Mailing Address - Phone:845-561-5220
Mailing Address - Fax:845-569-4697
Practice Address - Street 1:10 LITTLE BRITAIN RD STE 103
Practice Address - Street 2:
Practice Address - City:NEWBURGH
Practice Address - State:NY
Practice Address - Zip Code:12550-5161
Practice Address - Country:US
Practice Address - Phone:845-561-5220
Practice Address - Fax:845-569-4697
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-11
Last Update Date:2008-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY129905174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01025323Medicaid
NYB13917Medicare UPIN
NY01025323Medicaid