Individual provider Active NPI

Wladyslaw Sidorowicz, MD

  • Internal Medicine Physician
  • South Fallsburg, NY
National Provider Identifier
1205897881
Registry record updated Jul 13, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
1849651 Issued in NY
Practice address
4 Lincoln Rd
South Fallsburg, NY 12779
Phone
(845) 434-5858
Fax
(845) 434-5860
NPI assigned
Mar 31, 2006
Last updated
Jul 13, 2026By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 13, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 1849651 NY Primary

Addresses

Primary practice location

4 Lincoln Rd
South Fallsburg, NY 12779

Mailing address

PO Box 610
4 Lincoln Rd
South Fallsburg, NY 12779

Other identifiers 1

IdentifierTypeStateIssuer
01265618MedicaidNY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050608001155 NY Practitioner - Internal Medicine 4284677311 Practice locations: South Fallsburg, NY

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
1849651NYMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
RB Heart and Vascular Care PLLC Past Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1143763200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783900800000",
    "number": "1205897881",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 610",
            "address_2": "4 LINCOLN RD",
            "city": "SOUTH FALLSBURG",
            "state": "NY",
            "postal_code": "12779"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4 LINCOLN RD",
            "city": "SOUTH FALLSBURG",
            "state": "NY",
            "postal_code": "12779",
            "telephone_number": "845-434-5858",
            "fax_number": "845-434-5860"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SIDOROWICZ",
        "first_name": "WLADYSLAW",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-31",
        "last_updated": "2026-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NY",
            "license": "1849651",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01265618",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in South Fallsburg, NY

Sources for this page

Verify at the official NPI Registry.