MEDICARE: MAYER RYDZINSKI MD

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	207RC0000X	Cardiovascular Disease Physician	131957	NY

General Provider Information

NPI Number	:	1578639373
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAYER RYDZINSKI MD

Provider Business Mailing Address
First Line	:	200 OLD COUNTRY RD
Second Line	:	SUITE 278
City	:	MINEOLA
State	:	NY
Zip	:	11501-4235
Country	:	US
Telephone Number	:	516-877-0977
Fax Number	:	516-294-6861

Provider Business Practice Location Address
First Line	:	8002 KEW GARDENS RD
Second Line	:	SUITE 323
City	:	KEW GARDENS
State	:	NY
Zip	:	11415-3600
Country	:	US
Telephone Number	:	718-268-6300
Fax Number	:

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

Provider Enumeration Date	:	11/27/2006
Last Update Date	:	07/18/2014

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