Provider Demographics
NPI:1568511541
Name:ALBERT R WOLYNIEC DC PA
Entity Type:Organization
Organization Name:ALBERT R WOLYNIEC DC PA
Other - Org Name:WOLYNIEC CHIROPRACTIC GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF WOLYNIEC CHIROPRACTIC
Authorized Official - Prefix:DR
Authorized Official - First Name:ALBERT
Authorized Official - Middle Name:R
Authorized Official - Last Name:WOLYNIEC
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:201-652-5333
Mailing Address - Street 1:286 LINCOLN AVENUE
Mailing Address - Street 2:
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07450
Mailing Address - Country:US
Mailing Address - Phone:201-652-5333
Mailing Address - Fax:201-652-1165
Practice Address - Street 1:286 LINCOLN AVENUE
Practice Address - Street 2:
Practice Address - City:RIDGEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07450
Practice Address - Country:US
Practice Address - Phone:201-652-5333
Practice Address - Fax:201-652-1165
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-09
Last Update Date:2008-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00141700111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
597285AXKMedicare ID - Type Unspecified