Provider Demographics
NPI:1710157581
Name:SKENDER DRIZA MEDICAL PC
Entity Type:Organization
Organization Name:SKENDER DRIZA MEDICAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SKENDER
Authorized Official - Middle Name:
Authorized Official - Last Name:DRIZA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-417-7581
Mailing Address - Street 1:5916 69TH AVE
Mailing Address - Street 2:
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11385-4454
Mailing Address - Country:US
Mailing Address - Phone:718-417-7581
Mailing Address - Fax:718-417-7581
Practice Address - Street 1:6062 PALMETTO ST
Practice Address - Street 2:
Practice Address - City:RIDGEWOOD
Practice Address - State:NY
Practice Address - Zip Code:11385-3241
Practice Address - Country:US
Practice Address - Phone:718-821-4443
Practice Address - Fax:718-821-5785
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-07
Last Update Date:2008-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY245274261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center