Provider Demographics
NPI:1902887102
Name:DANZIGER, IRIS R (MD)
Entity Type:Individual
Prefix:
First Name:IRIS
Middle Name:R
Last Name:DANZIGER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1026 UNION RD
Mailing Address - Street 2:
Mailing Address - City:WEST SENECA
Mailing Address - State:NY
Mailing Address - Zip Code:14224-3449
Mailing Address - Country:US
Mailing Address - Phone:716-712-0855
Mailing Address - Fax:716-712-0982
Practice Address - Street 1:1026 UNION RD
Practice Address - Street 2:
Practice Address - City:WEST SENECA
Practice Address - State:NY
Practice Address - Zip Code:14224-3449
Practice Address - Country:US
Practice Address - Phone:716-712-0855
Practice Address - Fax:716-712-0982
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-07
Last Update Date:2017-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY177744207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01272288Medicaid
NY040426002536OtherFIDELIS
NY000524977003OtherBC/BS
NY119878CWOtherPREFERRED CARE
NY1009799OtherIHA
NY00010040803OtherUNIVERA
NY00010040803OtherUNIVERA
F01876Medicare UPIN
NYDD4193Medicare PIN