Provider Demographics
NPI:1225069156
Name:OLENGINSKI, JAN A (DO)
Entity Type:Individual
Prefix:DR
First Name:JAN
Middle Name:A
Last Name:OLENGINSKI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:8400 ROOSEVELT BLVD
Mailing Address - Street 2:SUITE 220
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19152-2081
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
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2013-01-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAOS007521L208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0000870897OtherBLUESHIELD
PA0015930390002Medicaid
PA0000870897OtherBLUESHIELD
PAG27759Medicare UPIN