Wacendak, John

Wacendak, John is an individual health care provider with primary practice located at 40 Arch St , Johnson City NY 13790-2102. He recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as his primary health care specialty. Wacendak, John can be contacted via phone (607) 763-6075.

Contact Information

Primary practice address
40 Arch St Johnson City NY 13790-2102
Phone: (607) 763-6075
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X 194762 New York

Profile Details

NPI number 1932196284
LBN Legal business name Wacendak, John
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Oct 3rd, 2005
Last updated Nov 19th, 2011 - about 13 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1932196284 NPPES
New York MEDICAID 01565544

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