Provider Demographics
NPI:1891482873
Name:TSADYK, DAVID
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:TSADYK
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18548 80TH RD
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11432-5807
Mailing Address - Country:US
Mailing Address - Phone:347-753-7953
Mailing Address - Fax:
Practice Address - Street 1:9418 59TH AVE
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373-5151
Practice Address - Country:US
Practice Address - Phone:718-271-2500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-20
Last Update Date:2025-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT14155122300000X
NY064210122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist