Provider Demographics
NPI:1134318298
Name:WASILOWSKI, ERIC DOUGLAS (DO)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:DOUGLAS
Last Name:WASILOWSKI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 JACKSON ST APT 1A
Mailing Address - Street 2:
Mailing Address - City:HOBOKEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07030-6084
Mailing Address - Country:US
Mailing Address - Phone:206-313-0892
Mailing Address - Fax:
Practice Address - Street 1:122 JACKSON ST APT 1A
Practice Address - Street 2:
Practice Address - City:HOBOKEN
Practice Address - State:NJ
Practice Address - Zip Code:07030-6084
Practice Address - Country:US
Practice Address - Phone:206-313-0892
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-15
Last Update Date:2020-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02003861A207P00000X
OH58.001515207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty