MEDICARE: DR. EDYTA C PIROG M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	206887	NY

General Provider Information

NPI Number	:	1023051786
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EDYTA C PIROG M.D.

Provider Business Mailing Address
First Line	:	BOX 29409,GPO
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10087-9409
Country	:	US
Telephone Number	:	646-253-2808
Fax Number	:	212-746-3856

Provider Business Practice Location Address
First Line	:	525 EAST 68TH STREET
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10087-9409
Country	:	US
Telephone Number	:	646-253-2808
Fax Number	:	212-746-3856

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/13/2006
Last Update Date	:	07/08/2007

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