Basic Information
Provider Information
NPI: 1942688510
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: WOJCIK
FirstName: JAKUB
MiddleName: TOMASZ
NamePrefix: DR.
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 908 NIAGARA FALLS BLVD STE 208
Address2:  
City: NORTH TONAWANDA
State: NY
PostalCode: 141202019
CountryCode: US
TelephoneNumber: 7166923302
FaxNumber: 7166924342
Practice Location
Address1: 116 INTERSTATE PKWY STE 41
Address2:  
City: BRADFORD
State: PA
PostalCode: 16701
CountryCode: US
TelephoneNumber: 8143639484
FaxNumber: 8143623854
Other Information
ProviderEnumerationDate: 05/14/2015
LastUpdateDate: 09/07/2018
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207R00000XMD465627PAY Allopathic & Osteopathic PhysiciansInternal Medicine 

No ID Information.


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