MEDICARE: MR. TADEUSZ PYZ 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	173000000X	Legal Medicine	MA2504456200	NJ
2	207Q00000X	Family Medicine Physician	25MA04456200	NJ
3	207Q00000X	Family Medicine Physician	177076-1	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1518957109
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. TADEUSZ PYZ M.D.

Provider Business Mailing Address
First Line	:	379 MAIN AVE
Second Line	:	SUITE 3
City	:	WALLINGTON
State	:	NJ
Zip	:	07057
Country	:	US
Telephone Number	:	973-779-2277
Fax Number	:	973-340-2561

Provider Business Practice Location Address
First Line	:	379 MAIN AVE
Second Line	:	SUITE 3
City	:	WALLINGTON
State	:	NJ
Zip	:	07057
Country	:	US
Telephone Number	:	973-779-2277
Fax Number	:	973-340-2561

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

Provider Enumeration Date	:	10/25/2005
Last Update Date	:	04/28/2010

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