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General NPI Number Information
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NPI Number | 1356618193
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Entity Type | Organization
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Legal Business Name | INGEBORG DZIEDZIC, M.D., P.C.
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Dates
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Enumeration Date | 11/22/2011
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Last Update Date | 12/20/2011
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Provider Practice Location Address
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Address Line | 320 MANVILLE RD
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City | PLEASANTVILLE
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State | NY
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Zip | 10570-2146
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Country | US
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Telephone | 914-769-0400
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Fax | 914-769-1405
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Provider Business Mailing Address
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Address Line | 320 MANVILLE RD
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City | PLEASANTVILLE
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State | NY
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Zip | 10570-2146
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Country | US
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Telephone | 914-769-0400
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Fax | 914-769-1405
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Authorized Official
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Title or Position | BILLING REPRESENTATIVE
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Name | MRS. NORA DEMPSEY
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Credential |
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Telephone | 914-769-0400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number | 153848-1
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License Number State | NY
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