Provider Demographics
NPI:1508882267
Name:WOJTCZAK, JACEK A (MD)
Entity Type:Individual
Prefix:DR
First Name:JACEK
Middle Name:A
Last Name:WOJTCZAK
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 1:601 ELMWOOD AVE
Mailing Address - Street 2:BOX 604
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14642-0001
Mailing Address - Country:US
Mailing Address - Phone:585-275-5982
Mailing Address - Fax:585-756-0169
Practice Address - Street 1:601 ELMWOOD AVE
Practice Address - Street 2:BOX 604
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14642-0001
Practice Address - Country:US
Practice Address - Phone:585-275-5982
Practice Address - Fax:585-756-0169
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY183472207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYMDA522OtherPREFERRED CARE
NY5052693OtherAETNA
NY000912474001OtherBS WNY/HEALTHNOW
NYG0189393590OtherBLUE CHOICE GROUP
NY00040770801OtherUNIVERA
NY183472-0OtherWORKER'S COMP
NY2101250OtherGHI
NY965779OtherMVP PROVIDER
NY2222OtherBLUE SHIELD
NY01260824Medicaid
NY000912474001OtherBS WNY/HEALTHNOW
NY2222OtherBLUE SHIELD