MEDICARE: JOHN J. WASNIEWSKI JR. DO PC

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	207Q00000X	Family Medicine Physician

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	107718	OTHER	PA	MEDICARE ID

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	1598762402	OTHER	PA	NPI PRIVATE PROVIDER

General Provider Information

NPI Number	:	1427188937
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOHN J. WASNIEWSKI JR. DO PC

Provider Business Mailing Address
First Line	:	2136 W PASSYUNK AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19145-3415
Country	:	US
Telephone Number	:	215-271-0101
Fax Number	:	215-334-7259

Provider Business Practice Location Address
First Line	:	2136 W PASSYUNK AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19145-3415
Country	:	US
Telephone Number	:	215-271-0101
Fax Number	:	215-334-7259

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JOHN JOSEPH WASNIEWSKI
Credential	:	DO
Telephone Number	:	215-271-0101

Provider Enumeration Date	:	03/06/2007
Last Update Date	:	03/27/2008

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