Provider Demographics
NPI:1518957109
Name:PYZ, TADEUSZ (MD)
Entity Type:Individual
Prefix:MR
First Name:TADEUSZ
Middle Name:
Last Name:PYZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:379 MAIN AVE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:WALLINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07057
Mailing Address - Country:US
Mailing Address - Phone:973-779-2277
Mailing Address - Fax:973-340-2561
Practice Address - Street 1:379 MAIN AVE
Practice Address - Street 2:SUITE 3
Practice Address - City:WALLINGTON
Practice Address - State:NJ
Practice Address - Zip Code:07057
Practice Address - Country:US
Practice Address - Phone:973-779-2277
Practice Address - Fax:973-340-2561
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-25
Last Update Date:2010-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA2504456200173000000X
NJ25MA04456200207Q00000X
NY177076-1207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No173000000XOther Service ProvidersLegal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7074301Medicaid
NJC09791Medicare UPIN
NJ7074301Medicaid