Healthcare Provider Details

I. General information

NPI: 1194735803
Provider Name (Legal Business Name): CAROL D WOJCIK PAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 SAINT ANDREWS LN
GLEN COVE NY
11542-2254
US

IV. Provider business mailing address

36 ALPINE LN
HICKSVILLE NY
11801-4460
US

V. Phone/Fax

Practice location:
  • Phone: 516-674-7591
  • Fax:
Mailing address:
  • Phone: 516-932-0227
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number002684-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: