MEDICARE: DR. NANCY WZONTEK PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	PS006188L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	749192	OTHER	PA	BCBS

General Provider Information

NPI Number	:	1699860254
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NANCY WZONTEK PHD

Provider Business Mailing Address
First Line	:	1315 WALNUT ST STE 1700
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19107-4717
Country	:	US
Telephone Number	:	610-595-4378
Fax Number	:

Provider Business Practice Location Address
First Line	:	1315 WALNUT ST STE 1700
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19107-4717
Country	:	US
Telephone Number	:	610-595-4378
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/03/2006
Last Update Date	:	11/02/2021

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