Provider Demographics
NPI:1033164215
Name:OLENGINSKI, JON J (DO)
Entity Type:Individual
Prefix:
First Name:JON
Middle Name:J
Last Name:OLENGINSKI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:100 N ACADEMY AVE
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17822-4903
Mailing Address - Country:US
Mailing Address - Phone:570-271-6144
Mailing Address - Fax:570-271-6578
Practice Address - Street 1:128 E MAIN ST
Practice Address - Street 2:
Practice Address - City:NANTICOKE
Practice Address - State:PA
Practice Address - Zip Code:18634-1604
Practice Address - Country:US
Practice Address - Phone:570-258-1304
Practice Address - Fax:570-258-1305
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2020-08-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAOS007908L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA002459OtherFIRST PRIORITY HEALTH
PA0015426390004Medicaid
PA20460OtherGEISINGER HEALTH PLAN
PA787926OtherHIGHMARK BLUE SHIELD
PA129715OtherHEALTH AMERICA
PA787926OtherFIRST PRIORITY LIFE
PA020017400OtherBLACK LUNG
PA020017400OtherBLACK LUNG
PA787926PFDMedicare PIN