Healthcare Provider Details

I. General information

NPI: 1558046458
Provider Name (Legal Business Name): NATHAN WOJICK
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/19/2023
Last Update Date: 06/19/2023
Certification Date: 06/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 ST LUKES LN
STROUDSBURG PA
18360-6217
US

IV. Provider business mailing address

100 ST LUKES LN
STROUDSBURG PA
18360-6217
US

V. Phone/Fax

Practice location:
  • Phone: 272-212-1000
  • Fax:
Mailing address:
  • Phone: 272-212-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: