=====================================================
General NPI Number Information
=====================================================
NPI Number | 1336272616
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ANGELA B KEDZIOR MD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/14/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | SOUTH BRONX HEALTH CENTER 871 PROSPECT AVENUE
-----------------------------------------------------
City | BRONX
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10459
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-991-0605
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 31 CLIFF STREET
-----------------------------------------------------
City | HASTINGS ON HUDSON
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10706
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 914-591-6039
-----------------------------------------------------
Fax | 718-991-2931
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number | 199278
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------