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NPI Code Detail

MEDICARE: MR. ADAM SIUZDAK PA

MEDICARE: MR. ADAM SIUZDAK PA
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
1363A00000XPhysician Assistant023515-1NY

General Provider Information

NPI Number : 1669940185
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. ADAM SIUZDAK PA
Provider Business Mailing Address
First Line : 343 GEORGE ST
Second Line :
City : SOUTH AMBOY
State : NJ
Zip : 08879-1739
Country : US
Telephone Number : 908-217-6817
Fax Number :
Provider Business Practice Location Address
First Line : 4143 HYLAN BLVD
Second Line :
City : STATEN ISLAND
State : NY
Zip : 10308-3308
Country : US
Telephone Number : 718-233-1300
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/02/2018
Last Update Date : 07/29/2019

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