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General NPI Number Information
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NPI Number | 1699756718
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Entity Type | Individual
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Provider Name | TATIANA DOBERCZAK MD
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Gender | Female
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Dates
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Enumeration Date | 11/07/2005
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Last Update Date | 01/12/2012
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Provider Practice Location Address
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Address Line | 16TH STREET AT 1ST AVENUE BIMC DEPT OF PEDIATRICS
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City | NEW YORK
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State | NY
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Zip | 10003
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Country | US
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Telephone | 212-420-4170
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 95000-2436
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City | PHILADELPHIA
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State | PA
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Zip | 19195-2436
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Country | US
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Telephone | 212-420-4170
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 136994
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License Number State | NY
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