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General NPI Number Information
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NPI Number | 1851474035
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Entity Type | Organization
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Legal Business Name | MARK KASZCZAK PHYSICIAN PC
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Dates
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Enumeration Date | 10/23/2006
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Last Update Date | 04/13/2011
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Provider Practice Location Address
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Address Line | 69 WARING PLACE
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City | YONKERS
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State | NY
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Zip | 10703
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Country | US
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Telephone | 914-969-1775
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Fax | 914-969-2415
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Provider Business Mailing Address
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Address Line | 69 WARING PLACE
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City | YONKERS
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State | NY
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Zip | 10703
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Country | US
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Telephone | 914-969-1775
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Fax | 914-969-2415
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Authorized Official
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Title or Position | MD
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Name | MARK ANDREW KASZCZAK
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Credential | MD
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Telephone | 914-969-1775
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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 | 178179
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License Number State | NY
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