Basic Information
| Provider Information | |||||||||
| NPI: | 1164513255 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | POGODZINSKA | ||||||||
| FirstName: | JUSTYNA | ||||||||
| MiddleName: | I | ||||||||
| NamePrefix: | DR. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 215 E 95TH ST | ||||||||
| Address2: | |||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 101284077 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2129968000 | ||||||||
| FaxNumber: | 2124233127 | ||||||||
| Practice Location | |||||||||
| Address1: | 215 E 95TH ST | ||||||||
| Address2: | |||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 101284077 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2129968000 | ||||||||
| FaxNumber: | 2124233127 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/27/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 182727-1 | NY | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 01511999 | 05 | NY | MEDICAID |