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Individual

DAVID WIDJAJA

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
1650 GRAND CONCOURSE, BRONX, NY 10457-7606
(718) 960-1234
Mailing address
1650 SELWYN AVE, 10TH FLOOR, BRONX, NY 10457-7626
(718) 960-1234

Taxonomy

Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
275018
NY
207RG0100X
Gastroenterology Physician
Primary
275018
NY
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
275018
NY

Other

Enumeration date
06/11/2008
Last updated
05/14/2014
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