Healthcare Provider Details

I. General information

NPI: 1790725125
Provider Name (Legal Business Name): ADAM S BUDZIKOWSKI M.D., PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2006
Last Update Date: 09/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

445 LENOX RD SUNY DOWSTATE DIV. CARDIOVASCULAR MEDICINE BOX 1199
BROOKLYN NY
11203-2017
US

IV. Provider business mailing address

445 LENOX RD SUNY DOWSTATE DIV. CARDIOVASCULAR MEDICINE BOX 1199
BROOKLYN NY
11203-2017
US

V. Phone/Fax

Practice location:
  • Phone: 718-270-4147
  • Fax: 718-270-4106
Mailing address:
  • Phone: 718-270-4147
  • Fax: 718-270-4106

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number219902
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number219902
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number219902
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: