=====================================================
General NPI Number Information
=====================================================
NPI Number | 1285792077
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | EDWARD JOHN WOJNIAK JR. PH.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/05/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3620 N. HIGH STREET SUITE 209
-----------------------------------------------------
City | COLUMBUS
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43214-3643
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 614-268-3939
-----------------------------------------------------
Fax | 614-269-3949
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3620 N. HIGH STREET SUITE 209
-----------------------------------------------------
City | COLUMBUS
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43214
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 614-268-3939
-----------------------------------------------------
Fax | 614-269-3949
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103T00000X
-----------------------------------------------------
Taxonomy Name | Psychologist
-----------------------------------------------------
License Number | 5218
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------