Provider Demographics
NPI:1598879801
Name:JANDZINSKI, DANA I (MD)
Entity Type:Individual
Prefix:DR
First Name:DANA
Middle Name:I
Last Name:JANDZINSKI
Suffix:
Gender:F
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:PO BOX 678207
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75267-8207
Mailing Address - Country:US
Mailing Address - Phone:800-841-4236
Mailing Address - Fax:706-653-1162
Practice Address - Street 1:3040 AMSDELL RD
Practice Address - Street 2:
Practice Address - City:HAMBURG
Practice Address - State:NY
Practice Address - Zip Code:14075-5835
Practice Address - Country:US
Practice Address - Phone:716-649-9000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2021-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2369882085R0202X
SC815412085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00027790001OtherUNIVERA HEALTHCARE
NY02775253Medicaid
NY187540FFOtherPREFERRED CARE
NY000930199002OtherBCBS
NYP00658341OtherRR MEDICARE
NY1609206OtherINDEPENDENT HEALTH
NY061024000039OtherFIDELIS CARE OF NY
NYRB2423Medicare PIN
NY02775253Medicaid