1134102700 NPI number — PAUL S DZIWIS MD

Table of content: PAUL S DZIWIS MD (NPI 1134102700)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134102700 NPI number — PAUL S DZIWIS MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DZIWIS
Provider First Name:
PAUL
Provider Middle Name:
S
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1134102700
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/08/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2080 CLINTON AVE SOUTH
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROCHESTER
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14618
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
585-271-2800
Provider Business Mailing Address Fax Number:
585-271-0375

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2080 CLINTON AVE SOUTH
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROCHESTER
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14618
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
585-271-2800
Provider Business Practice Location Address Fax Number:
585-271-0375
Provider Enumeration Date:
11/28/2005

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: 207RG0100X , with the licence number:  169747 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 5149341 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 101178BT . This is a "PREFERRED CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7702333 . This is a "MVP" identifier . This identifiers is of the category "OTHER".
  • Identifier: P020169747 . This is a "EXCELLUS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 01278404 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4V2821 . This is a "EMPIRE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 100016850 . This is a "MEDICARE RAILROA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2692405 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000919374001 . This is a "HEALTH NOW" identifier . This identifiers is of the category "OTHER".
  • Identifier: P010169747 . This is a "EXCELLUS" identifier . This identifiers is of the category "OTHER".




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