Healthcare Provider Details

I. General information

NPI: 1518047737
Provider Name (Legal Business Name): BEATA DYGULSKA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/16/2006
Last Update Date: 10/12/2023
Certification Date: 10/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

263 7TH AVE
BROOKLYN NY
11215-3689
US

IV. Provider business mailing address

263 7TH AVE
BROOKLYN NY
11215-3689
US

V. Phone/Fax

Practice location:
  • Phone: 718-246-8510
  • Fax:
Mailing address:
  • Phone: 718-246-8510
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080P0006X
TaxonomyDevelopmental - Behavioral Pediatrics Physician
License Number1962681
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number1962681
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: