Basic Information
| Provider Information | |||||||||
| NPI: | 1356575625 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ANDRZEJ BULCZYNSKI M.D., INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 13160 MINDANAO WAY | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | MARINA DEL REY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 90292 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3105740400 | ||||||||
| FaxNumber: | 3105740485 | ||||||||
| Practice Location | |||||||||
| Address1: | 13160 MINDANAO WAY | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | MARINA DEL REY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 90292 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3105740400 | ||||||||
| FaxNumber: | 3105740485 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/14/2009 | ||||||||
| LastUpdateDate: | 03/28/2012 | ||||||||
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| AuthorizedOfficialLastName: | BULCZYNSKI | ||||||||
| AuthorizedOfficialFirstName: | ANDRZEJ | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | OWNER/PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 3105740400 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | A89040 | CA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
No ID Information.