Provider Demographics
NPI:1609015452
Name:DZIADOSZ, DANIEL R (MD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:R
Last Name:DZIADOSZ
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:PO BOX 29234
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10087-9234
Mailing Address - Country:US
Mailing Address - Phone:646-962-2904
Mailing Address - Fax:646-962-0845
Practice Address - Street 1:520 EAST 70TH STREET
Practice Address - Street 2:STARR2
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-9800
Practice Address - Country:US
Practice Address - Phone:646-962-2904
Practice Address - Fax:646-962-0845
Is Sole Proprietor?:No
Enumeration Date:2009-02-18
Last Update Date:2020-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY302025207X00000X, 207XX0801X, 207XX0801X, 207X00000X
VA0101248008207XX0801X
KY46778207XX0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Yes207XX0801XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Trauma
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003162720AMedicaid
FL328012OtherAVMED
FL9262296OtherAETNA
FL1186918OtherCIGNA
FL008527000Medicaid
FL14515OtherBCBS
FL14515OtherBCBS