Healthcare Provider Details

I. General information

NPI: 1851229421
Provider Name (Legal Business Name): PETER WOLANSKI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2026
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

319 E WATER ST
SYRACUSE NY
13202-1123
US

IV. Provider business mailing address

2006 W GENESEE ST APT 16
SYRACUSE NY
13219-1666
US

V. Phone/Fax

Practice location:
  • Phone: 315-671-0957
  • Fax: 315-475-4601
Mailing address:
  • Phone: 315-491-4251
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: