Healthcare Provider Details

I. General information

NPI: 1922633007
Provider Name (Legal Business Name): DANZI & HAJDUK-BENNETT PEDIATRICS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2020
Last Update Date: 03/09/2020
Certification Date: 03/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

994 W JERICHO TPKE STE 202
SMITHTOWN NY
11787-3234
US

IV. Provider business mailing address

994 W JERICHO TPKE STE 202
SMITHTOWN NY
11787-3234
US

V. Phone/Fax

Practice location:
  • Phone: 631-864-6440
  • Fax: 631-864-6445
Mailing address:
  • Phone: 631-864-6440
  • Fax: 631-864-6445

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: ANN MARGARET HAJDUK
Title or Position: DR
Credential: DO
Phone: 631-864-6440