Provider Demographics
NPI:1770641755
Name:SZCZESNIAK, JOSEPH W (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:W
Last Name:SZCZESNIAK
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 1344
Mailing Address - Street 2:
Mailing Address - City:ROSLYN HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11577-0694
Mailing Address - Country:US
Mailing Address - Phone:516-365-5206
Mailing Address - Fax:516-365-0602
Practice Address - Street 1:1077 NORTHERN BLVD
Practice Address - Street 2:
Practice Address - City:ROSLYN
Practice Address - State:NY
Practice Address - Zip Code:11576-1614
Practice Address - Country:US
Practice Address - Phone:516-365-5206
Practice Address - Fax:516-365-0602
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2017-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY169927207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
15F691Medicare ID - Type Unspecified
NYD92128Medicare UPIN