Provider Demographics
NPI:1619076346
Name:WOLYNSKI, BRYAN MICHAEL (OD)
Entity Type:Individual
Prefix:DR
First Name:BRYAN
Middle Name:MICHAEL
Last Name:WOLYNSKI
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 MADISON AVE FL 5
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10010-1600
Mailing Address - Country:US
Mailing Address - Phone:212-545-2400
Mailing Address - Fax:646-312-0481
Practice Address - Street 1:9704 SUTPHIN BLVD
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11435-4721
Practice Address - Country:US
Practice Address - Phone:718-657-7088
Practice Address - Fax:718-657-7092
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2019-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC 3623152W00000X
NYTUV006289-1152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02531822Medicaid
NYU88923Medicare UPIN