Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

David Widjaja, MD

Individual provider Gastroenterology Physician · NPI 1194985291

David Widjaja, MD is a Gastroenterology in Bronx, New York. Qualified in 1996, 30 years ago. Practices with Innovis Health LLC, a 573-clinician group and accepts Medicare assignment. Licensed in New York.

Years since qualifying
30
Licensed in
NY
In the registry since
2008
Specialties on file
3
What do these letters mean?
MD — Doctor of Medicine
A physician who completed allopathic medical school.

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Practice location Address checks out

1650 Grand Concourse
Bronx, NY 10457-7606
Phone: (718) 960-1234
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Gastroenterology Physician (primary) Taxonomy 207RG0100X · Licence 275018 (NY)
Geriatric Medicine (Internal Medicine) Physician Taxonomy 207RG0300X · Licence 275018 (NY)
Internal Medicine Physician Taxonomy 207R00000X · Licence 275018 (NY)

Record details

NPI number1194985291
Entity typeIndividual (Type 1)
GenderMale
Credentials MD
Sole proprietorNo
NPI enumeratedJune 11, 2008
Last updated in NPPESMay 14, 2014
Mailing address1650 Selwyn Ave, 10th Floor, Bronx, NY 10457-7626

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyGASTROENTEROLOGY
Medical schoolOTHER
Graduated 1996 (30 years in practice)
Group practice Innovis Health Llc — 573 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations2 on file with Medicare

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