Provider Demographics
NPI:1811091481
Name:DZIGAS, IRA MICHAEL (DPM)
Entity type:Individual
Prefix:DR
First Name:IRA
Middle Name:MICHAEL
Last Name:DZIGAS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:602 MERRICK AVE
Mailing Address - Street 2:
Mailing Address - City:EAST MEADOW
Mailing Address - State:NY
Mailing Address - Zip Code:11554-4731
Mailing Address - Country:US
Mailing Address - Phone:516-564-4433
Mailing Address - Fax:516-481-7690
Practice Address - Street 1:602 MERRICK AVE
Practice Address - Street 2:
Practice Address - City:EAST MEADOW
Practice Address - State:NY
Practice Address - Zip Code:11554-4731
Practice Address - Country:US
Practice Address - Phone:516-564-4433
Practice Address - Fax:516-481-7690
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN004295213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
0022528OtherGHI PROVIDER
AS1399OtherOXFORD
0022528OtherGHI PROVIDER
T51448Medicare UPIN