Provider Demographics
NPI:1033267463
Name:GENERAL & VASCULAR SURGICAL GROUP, P.C
Entity Type:Organization
Organization Name:GENERAL & VASCULAR SURGICAL GROUP, P.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:OLENGINSKI
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:215-331-7001
Mailing Address - Street 1:8400 ROOSEVELT BOULEVARD
Mailing Address - Street 2:SUITE 220
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19152-2029
Mailing Address - Country:US
Mailing Address - Phone:215-331-7001
Mailing Address - Fax:215-331-7004
Practice Address - Street 1:8400 ROOSEVELT BLVD
Practice Address - Street 2:SUITE 220
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19152-2081
Practice Address - Country:US
Practice Address - Phone:215-331-7001
Practice Address - Fax:215-331-7004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2013-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS007521L208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0016148180006Medicaid
PA0016148180006Medicaid
PA870590Medicare ID - Type Unspecified