Healthcare Provider Details

I. General information

NPI: 1851322432
Provider Name (Legal Business Name): DAVID WOJTASEK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 09/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 AMSTERDAM AVE
NEW YORK NY
10025
US

IV. Provider business mailing address

1780 BROADWAY 1100
NEW YORK NY
10019
US

V. Phone/Fax

Practice location:
  • Phone: 212-523-4272
  • Fax: 212-523-3798
Mailing address:
  • Phone: 212-590-2930
  • Fax: 212-590-2982

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0205X
TaxonomyRadiological Physics Physician
License Number152263
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: