Healthcare Provider Details

I. General information

NPI: 1427596261
Provider Name (Legal Business Name): GEORGE WASEK MSW, CASAC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/01/2017
Last Update Date: 02/01/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17515 ROCKAWAY BLVD
JAMAICA NY
11434-5503
US

IV. Provider business mailing address

17515 ROCKAWAY BLVD
JAMAICA NY
11434-5503
US

V. Phone/Fax

Practice location:
  • Phone: 718-632-3275
  • Fax: 718-632-7952
Mailing address:
  • Phone: 718-632-3275
  • Fax: 718-632-7952

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: