Basic Information
| Provider Information | |||||||||
| NPI: | 1891991287 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DEC | ||||||||
| FirstName: | WOJCIECH | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 343 E 30TH ST | ||||||||
| Address2: | APT. 12F | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100166417 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9175923147 | ||||||||
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| Practice Location | |||||||||
| Address1: | 550 1ST AVE | ||||||||
| Address2: | |||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100166402 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2126867500 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/22/2007 | ||||||||
| LastUpdateDate: | 10/29/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 2082S0099X | P5793 | TX | Y | Allopathic & Osteopathic Physicians | Plastic Surgery | Plastic Surgery Within the Head and Neck |
ID Information
| ID | Type | State | Issuer | Description | 319852501 (MDACC) | 05 | TX | MEDICAID | 8DV860 | 01 | TX | BCBS (MDACC) | OTHER |