Provider Demographics
NPI:1568463875
Name:DZIEDZIC, STANLEY WALTER (MD)
Entity type:Individual
Prefix:DR
First Name:STANLEY
Middle Name:WALTER
Last Name:DZIEDZIC
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1 GUSTAVE L LEVY PL
Mailing Address - Street 2:BOX 3000
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10029-6504
Mailing Address - Country:US
Mailing Address - Phone:212-987-3100
Mailing Address - Fax:212-731-5210
Practice Address - Street 1:234 E 85TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10028-3135
Practice Address - Country:US
Practice Address - Phone:212-241-6585
Practice Address - Fax:212-824-2335
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-09
Last Update Date:2016-02-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY134688207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
B15720Medicare UPIN
NY63F361Medicare ID - Type Unspecified