Active NPI
Ingeborg Dziedzic, M.D.
- Ophthalmology Physician
- Pleasantville, NY
National Provider Identifier
1376647800
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Ophthalmology Physician
- License
- 153848-1
- Practice address
- 320 Manville Rd
Pleasantville, NY 10570-2146 - Phone
- (914) 769-0400
- Fax
- (914) 769-1405
- NPI assigned
- Sep 13, 2006
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Ophthalmology Physician | 207W00000X | 153848-1 | NY | Primary |
Addresses
Primary practice location
320 Manville Rd
Pleasantville, NY 10570-2146
Mailing address
320 Manville Rd
Pleasantville, NY 10570-2146
Phone (914) 769-0400
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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20120120000563 | NY | Practitioner - Ophthalmology | 0446427140 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 153848-1 | NY | MD | Ophthalmology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1158105600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1411344000000",
"number": "1376647800",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "320 MANVILLE RD",
"city": "PLEASANTVILLE",
"state": "NY",
"postal_code": "105702146",
"telephone_number": "914-769-0400",
"fax_number": "914-769-1405"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "320 MANVILLE RD",
"city": "PLEASANTVILLE",
"state": "NY",
"postal_code": "105702146",
"telephone_number": "914-769-0400",
"fax_number": "914-769-1405"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DZIEDZIC",
"first_name": "INGEBORG",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-09-13",
"last_updated": "2014-09-22",
"status": "A"
},
"taxonomies": [
{
"code": "207W00000X",
"taxonomy_group": "",
"desc": "Ophthalmology",
"state": "NY",
"license": "153848-1",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Pleasantville, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 22, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.