Healthcare Provider Details

I. General information

NPI: 1841163243
Provider Name (Legal Business Name): JEREMY WASIK
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2025
Last Update Date: 10/30/2025
Certification Date: 10/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

810 CLAIRTON BLVD
PITTSBURGH PA
15236-5505
US

IV. Provider business mailing address

810 CLAIRTON BLVD STE 100
PITTSBURGH PA
15236-5505
US

V. Phone/Fax

Practice location:
  • Phone: 412-466-5004
  • Fax:
Mailing address:
  • Phone: 412-466-5004
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberOA007437
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: