Healthcare Provider Details

I. General information

NPI: 1164405585
Provider Name (Legal Business Name): JAN B WOJCIK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2005
Last Update Date: 10/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 CAREW STREET SUITE 110
SPRINGFIELD MA
01104
US

IV. Provider business mailing address

TRINITY HEALTH OF NE MED GRP - ATTN: PGREANEY 395 SOUTHAMPTON RD #100
WESTFIELD MA
01085-1324
US

V. Phone/Fax

Practice location:
  • Phone: 413-732-4269
  • Fax: 413-785-4619
Mailing address:
  • Phone: 413-485-4663
  • Fax: 413-562-1605

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number72523
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: