1518957109 NPI number — MR. TADEUSZ PYZ M.D.

Table of content: MR. TADEUSZ PYZ M.D. (NPI 1518957109)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518957109 NPI number — MR. TADEUSZ PYZ M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PYZ
Provider First Name:
TADEUSZ
Provider Middle Name:
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

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:
1518957109
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/28/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

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

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
379 MAIN AVE
Provider Second Line Business Practice Location Address:
SUITE 3
Provider Business Practice Location Address City Name:
WALLINGTON
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07057
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-779-2277
Provider Business Practice Location Address Fax Number:
973-340-2561
Provider Enumeration Date:
10/25/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 173000000X , with the licence number:  MA2504456200 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X , with the licence number: 177076-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X , with the licence number: 25MA04456200 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 7074301 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".