Provider Demographics
NPI:1285813667
Name:ROBERT M WOZNICKI MD PC
Entity Type:Organization
Organization Name:ROBERT M WOZNICKI MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:WOZNICKI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-928-3184
Mailing Address - Street 1:640 BELLE TERRE RD
Mailing Address - Street 2:SUITE 3 BLD J
Mailing Address - City:PORT JEFFERSON
Mailing Address - State:NY
Mailing Address - Zip Code:11777-1936
Mailing Address - Country:US
Mailing Address - Phone:631-928-3184
Mailing Address - Fax:631-928-3957
Practice Address - Street 1:640 BELLE TERRE RD
Practice Address - Street 2:BLDG J3
Practice Address - City:PORT JEFFERSON
Practice Address - State:NY
Practice Address - Zip Code:11777-1936
Practice Address - Country:US
Practice Address - Phone:631-928-3184
Practice Address - Fax:631-928-3957
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-01
Last Update Date:2013-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1775502084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYE26422Medicare UPIN
NYWVE471Medicare PIN