Provider Demographics
NPI:1407874787
Name:WOLOSZYN, THOMAS T (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:T
Last Name:WOLOSZYN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8417 FORT HAMILTON PKWY
Mailing Address - Street 2:GROUND FLOOR
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209-4805
Mailing Address - Country:US
Mailing Address - Phone:347-497-5587
Mailing Address - Fax:347-497-5957
Practice Address - Street 1:8417 FORT HAMILTON PKWY
Practice Address - Street 2:GROUND FLOOR
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-4805
Practice Address - Country:US
Practice Address - Phone:347-497-5587
Practice Address - Fax:347-497-5957
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2009-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY182400208200000X, 207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
No207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01679670Medicaid
20L981Medicare ID - Type Unspecified