Healthcare Provider Details

I. General information

NPI: 1992049167
Provider Name (Legal Business Name): JOSEPH W SZCZESNIAK MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/12/2012
Last Update Date: 01/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1077 NORTHERN BLVD
ROSLYN NY
11576-1614
US

IV. Provider business mailing address

1077 NORTHERN BLVD
ROSLYN NY
11576-1614
US

V. Phone/Fax

Practice location:
  • Phone: 516-365-5206
  • Fax: 516-365-0602
Mailing address:
  • Phone: 516-365-5206
  • Fax: 516-365-0602

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number169927
License Number StateNY

VIII. Authorized Official

Name: DR. JOSEPH W SZCZESNIAK
Title or Position: PRESIDENT
Credential: MD
Phone: 516-365-5206