Healthcare Provider Details

I. General information

NPI: 1851474035
Provider Name (Legal Business Name): MARK KASZCZAK PHYSICIAN PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2006
Last Update Date: 04/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

69 WARING PLACE
YONKERS NY
10703
US

IV. Provider business mailing address

69 WARING PLACE
YONKERS NY
10703
US

V. Phone/Fax

Practice location:
  • Phone: 914-969-1775
  • Fax: 914-969-2415
Mailing address:
  • Phone: 914-969-1775
  • Fax: 914-969-2415

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number178179
License Number StateNY

VIII. Authorized Official

Name: MARK ANDREW KASZCZAK
Title or Position: MD
Credential: MD
Phone: 914-969-1775