Provider Demographics
NPI:1689835951
Name:DZIEDZIC, DANIELLE THERESA (MD)
Entity Type:Individual
Prefix:DR
First Name:DANIELLE
Middle Name:THERESA
Last Name:DZIEDZIC
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 1:70 GILBERT ST
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:NY
Mailing Address - Zip Code:10950-1538
Mailing Address - Country:US
Mailing Address - Phone:845-783-5723
Mailing Address - Fax:
Practice Address - Street 1:70 GILBERT ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:NY
Practice Address - Zip Code:10950-1538
Practice Address - Country:US
Practice Address - Phone:845-783-5723
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-19
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY246049208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics