Healthcare Provider Details

I. General information

NPI: 1356314058
Provider Name (Legal Business Name): JANA PODZIMEK D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/12/2006
Last Update Date: 08/03/2022
Certification Date: 08/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

77 NELSON ST STE 130
AUBURN NY
13021-1941
US

IV. Provider business mailing address

77 NELSON ST STE 130
AUBURN NY
13021-1941
US

V. Phone/Fax

Practice location:
  • Phone: 315-255-3300
  • Fax:
Mailing address:
  • Phone: 315-255-3300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0007X
TaxonomyPlastic Surgery within the Head & Neck (Otolaryngology) Physician
License Number036-078953
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: