Provider Demographics
NPI:1104295112
Name:ADAM S BUDZIKOWSKI, PHYSICIAN PC
Entity type:Organization
Organization Name:ADAM S BUDZIKOWSKI, PHYSICIAN PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:S
Authorized Official - Last Name:BUDZIKOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PHD
Authorized Official - Phone:914-441-3081
Mailing Address - Street 1:288 CLOVE RD
Mailing Address - Street 2:
Mailing Address - City:NEW ROCHELLE
Mailing Address - State:NY
Mailing Address - Zip Code:10804-3506
Mailing Address - Country:US
Mailing Address - Phone:914-441-3081
Mailing Address - Fax:
Practice Address - Street 1:5968 GRAND AVE
Practice Address - Street 2:
Practice Address - City:MASPETH
Practice Address - State:NY
Practice Address - Zip Code:11378-2733
Practice Address - Country:US
Practice Address - Phone:929-252-9330
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-20
Last Update Date:2015-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
219902-01OtherNEIGHBOURHOOD
7260065OtherCIGNA
P3944259OtherOXFORD
0167125OtherGHI
1000059162OtherAFFINITY
6C5402OtherHEALTHNET
070730000057OtherFIDELIS
1000059162OtherAETNA
1043411OtherAMERIGROUP
187119OtherELDERPLAN
2124279OtherUNITED HEALTHCARE
070730000057OtherCENTERCARE
219902OtherEMBLEM
219902-A18OtherHEALTH FIRST
523610101OtherHEALTH PLUS
NY02650493Medicaid
219902-NYOther1199
523610101OtherHEALTH PLUS