Basic Information
| Provider Information | |||||||||
| NPI: | 1376765198 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SYPEK | ||||||||
| FirstName: | TADEUSZ | ||||||||
| MiddleName: | M | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | SYPEK | ||||||||
| OtherFirstName: | TED | ||||||||
| OtherMiddleName: | M | ||||||||
| OtherNamePrefix: | DR. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | M.D. | ||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 32 IRIS CIRCLE | ||||||||
| Address2: | |||||||||
| City: | BEACON | ||||||||
| State: | NY | ||||||||
| PostalCode: | 12508 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8458762011 | ||||||||
| FaxNumber: | 8458767119 | ||||||||
| Practice Location | |||||||||
| Address1: | 21 FERNCLIFF DRIVE | ||||||||
| Address2: | |||||||||
| City: | RHINEBECK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 125721900 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8458762011 | ||||||||
| FaxNumber: | 8458767119 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/02/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
| AuthorizedOfficialLastName: | |||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | Y | ||||||||
| IsOrganizationSubpart: | |||||||||
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| AuthorizedOfficialNameSuffix: | |||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208D00000X | 106172-1 | NY | Y | Allopathic & Osteopathic Physicians | General Practice |
ID Information
| ID | Type | State | Issuer | Description | 00532247 | 05 | NY | MEDICAID |