Provider Demographics
NPI:1356618193
Name:INGEBORG DZIEDZIC, M.D., P.C.
Entity type:Organization
Organization Name:INGEBORG DZIEDZIC, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING REPRESENTATIVE
Authorized Official - Prefix:MRS
Authorized Official - First Name:NORA
Authorized Official - Middle Name:
Authorized Official - Last Name:DEMPSEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:914-769-0400
Mailing Address - Street 1:320 MANVILLE RD
Mailing Address - Street 2:
Mailing Address - City:PLEASANTVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:10570-2146
Mailing Address - Country:US
Mailing Address - Phone:914-769-0400
Mailing Address - Fax:914-769-1405
Practice Address - Street 1:320 MANVILLE RD
Practice Address - Street 2:
Practice Address - City:PLEASANTVILLE
Practice Address - State:NY
Practice Address - Zip Code:10570-2146
Practice Address - Country:US
Practice Address - Phone:914-769-0400
Practice Address - Fax:914-769-1405
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-22
Last Update Date:2011-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY153848-1302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA64906Medicare UPIN