Provider Demographics
NPI:1689744526
Name:WASYLIW, OREST MYROSLAV (MD)
Entity Type:Individual
Prefix:
First Name:OREST
Middle Name:MYROSLAV
Last Name:WASYLIW
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 1:441 RIVERSIDE DRIVE
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:NY
Mailing Address - Zip Code:13790-2711
Mailing Address - Country:US
Mailing Address - Phone:607-729-2474
Mailing Address - Fax:607-770-9271
Practice Address - Street 1:441 RIVERSIDE DRIVE
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:NY
Practice Address - Zip Code:13790-2711
Practice Address - Country:US
Practice Address - Phone:607-729-2474
Practice Address - Fax:607-770-9271
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2011-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY127451207X00000X
PAMD038483E207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00790607Medicaid
B41139Medicare UPIN
NY00790607Medicaid