Provider Demographics
NPI:1629080023
Name:MULARCZYK, EDYTA KRZAK (MD)
Entity Type:Individual
Prefix:
First Name:EDYTA
Middle Name:KRZAK
Last Name:MULARCZYK
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 1:1001 NW 13TH ST STE 201
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33486-2269
Mailing Address - Country:US
Mailing Address - Phone:561-955-6663
Mailing Address - Fax:561-955-2879
Practice Address - Street 1:8200 S JOG RD
Practice Address - Street 2:STE 102
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33472-2981
Practice Address - Country:US
Practice Address - Phone:561-733-3970
Practice Address - Fax:561-733-3690
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-13
Last Update Date:2022-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME108778207R00000X
NY233599207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL33803AOtherPTAN
FLFF030ZMedicare UPIN
NY4C8726OtherHEALTH NET
NY1078581OtherAETNA - HMO
NY2580945OtherUNITED HEALTHCARE
NY049SM2Medicare PIN
NYP00370944Medicare PIN
I20650Medicare UPIN
NY69866483OtherCIGNA
NYPENDING 1ST CLAIMOtherRAILROAD MEDICARE
NY7417726OtherAETNA - PPO