Provider Demographics
NPI:1265447304
Name:LISTOPADZKI, DARIUSZ JARSLAW (MD)
Entity type:Individual
Prefix:
First Name:DARIUSZ
Middle Name:JARSLAW
Last Name:LISTOPADZKI
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 1:571 SAINT JOSEPHS BLVD FL 2
Mailing Address - Street 2:
Mailing Address - City:ELMIRA
Mailing Address - State:NY
Mailing Address - Zip Code:14901-3230
Mailing Address - Country:US
Mailing Address - Phone:607-271-2050
Mailing Address - Fax:
Practice Address - Street 1:418 S HAMILTON ST
Practice Address - Street 2:SUITE 109
Practice Address - City:PAINTED POST
Practice Address - State:NY
Practice Address - Zip Code:14870-9705
Practice Address - Country:US
Practice Address - Phone:607-936-2089
Practice Address - Fax:607-936-8176
Is Sole Proprietor?:No
Enumeration Date:2006-07-29
Last Update Date:2016-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY234124207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02618582Medicaid
PA102812894Medicaid
PA102812894Medicaid
P00190405Medicare ID - Type UnspecifiedRR INDIVIDUAL #