MEDICARE: DR. JAN A OLENGINSKI D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208600000X	Surgery Physician	OS007521L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0000870897	OTHER	PA	BLUESHIELD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1225069156
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAN A OLENGINSKI D.O.

Provider Business Mailing Address
First Line	:	8400 ROOSEVELT BLVD
Second Line	:	SUITE 220
City	:	PHILADELPHIA
State	:	PA
Zip	:	19152-2081
Country	:	US
Telephone Number	:	215-331-7001
Fax Number	:	215-331-7004

Provider Business Practice Location Address
First Line	:	8400 ROOSEVELT BLVD
Second Line	:	SUITE 220
City	:	PHILADELPHIA
State	:	PA
Zip	:	19152-2081
Country	:	US
Telephone Number	:	215-331-7001
Fax Number	:	215-331-7004

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/06/2006
Last Update Date	:	01/17/2013

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