Provider Demographics
NPI:1487793303
Name:LYDON & SAWCZAK MD PA
Entity type:Organization
Organization Name:LYDON & SAWCZAK MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TONI
Authorized Official - Middle Name:A
Authorized Official - Last Name:SAWCZAK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:772-334-2444
Mailing Address - Street 1:2050 NE DIXIE HWY
Mailing Address - Street 2:
Mailing Address - City:JENSEN BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:34957-6441
Mailing Address - Country:US
Mailing Address - Phone:772-334-2444
Mailing Address - Fax:772-334-4122
Practice Address - Street 1:2050 NE DIXIE HWY
Practice Address - Street 2:
Practice Address - City:JENSEN BEACH
Practice Address - State:FL
Practice Address - Zip Code:34957-6441
Practice Address - Country:US
Practice Address - Phone:772-334-2444
Practice Address - Fax:772-334-4122
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-06
Last Update Date:2011-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL372254600Medicaid
FL372254600Medicaid