Healthcare Provider Details

I. General information

NPI: 1104042886
Provider Name (Legal Business Name): EZRA E DWECK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2007
Last Update Date: 09/11/2025
Certification Date: 09/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 E 17TH ST SUITE 550
NEW YORK NY
10003-3804
US

IV. Provider business mailing address

301 E 17TH ST SUITE 550
NEW YORK NY
10003-3804
US

V. Phone/Fax

Practice location:
  • Phone: 212-598-6422
  • Fax: 212-598-6045
Mailing address:
  • Phone: 212-598-6422
  • Fax: 212-598-6045

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number233669
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number25MA09825500
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number25MA09825500
License Number StateNJ
# 4
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number233669
License Number StateNY
# 5
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number25MA09825500
License Number StateNJ
# 6
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number233669
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: