1104295112 NPI number — ADAM S BUDZIKOWSKI, PHYSICIAN PC

Table of content: (NPI 1104295112)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104295112 NPI number — ADAM S BUDZIKOWSKI, PHYSICIAN PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ADAM S BUDZIKOWSKI, PHYSICIAN PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1104295112
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/20/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
288 CLOVE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW ROCHELLE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10804-3506
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
914-441-3081
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5968 GRAND AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MASPETH
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11378-2733
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
929-252-9330
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/20/2015

Additional Information

Authorized Official

Authorized Official Last Name:
BUDZIKOWSKI
Authorized Official First Name:
ADAM
Authorized Official Middle Name:
S
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
914-441-3081

Provider Taxonomy Codes

  • Taxonomy code: 261QM2500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 219902-01 . This is a "NEIGHBOURHOOD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7260065 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: P3944259 . This is a "OXFORD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0167125 . This is a "GHI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1000059162 . This is a "AFFINITY" identifier . This identifiers is of the category "OTHER".
  • Identifier: 6C5402 . This is a "HEALTHNET" identifier . This identifiers is of the category "OTHER".
  • Identifier: 070730000057 . This is a "FIDELIS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1000059162 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1043411 . This is a "AMERIGROUP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 187119 . This is a "ELDERPLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2124279 . This is a "UNITED HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 070730000057 . This is a "CENTERCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 219902 . This is a "EMBLEM" identifier . This identifiers is of the category "OTHER".
  • Identifier: 219902-A18 . This is a "HEALTH FIRST" identifier . This identifiers is of the category "OTHER".
  • Identifier: 523610101 . This is a "HEALTH PLUS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 02650493 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 219902-NY . This is a "1199" identifier . This identifiers is of the category "OTHER".




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