Provider Demographics
NPI:1679527196
Name:PODHORODECKI, ARETA D (MD)
Entity Type:Individual
Prefix:DR
First Name:ARETA
Middle Name:D
Last Name:PODHORODECKI
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 1:44 SAINT MARKS PL
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003-8118
Mailing Address - Country:US
Mailing Address - Phone:212-529-5966
Mailing Address - Fax:
Practice Address - Street 1:44 SAINT MARKS PL
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-8118
Practice Address - Country:US
Practice Address - Phone:212-529-5966
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY166518208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00978721Medicaid
NY00978721Medicaid
NYA64016Medicare UPIN