Provider Demographics
NPI:1851474035
Name:MARK KASZCZAK PHYSICIAN PC
Entity Type:Organization
Organization Name:MARK KASZCZAK PHYSICIAN PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:KASZCZAK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:914-969-1775
Mailing Address - Street 1:69 WARING PLACE
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10703
Mailing Address - Country:US
Mailing Address - Phone:914-969-1775
Mailing Address - Fax:914-969-2415
Practice Address - Street 1:69 WARING PLACE
Practice Address - Street 2:
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10703
Practice Address - Country:US
Practice Address - Phone:914-969-1775
Practice Address - Fax:914-969-2415
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-23
Last Update Date:2011-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY178179208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01162665Medicaid
NY01162665Medicaid
37F53Medicare ID - Type Unspecified