Provider Demographics
NPI:1780669101
Name:WNOROWSKI, BRIAN RICHARD (MD)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:RICHARD
Last Name:WNOROWSKI
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 1:506 NORMANDY DR
Mailing Address - Street 2:
Mailing Address - City:MANTOLOKING
Mailing Address - State:NJ
Mailing Address - Zip Code:08738-1903
Mailing Address - Country:US
Mailing Address - Phone:908-670-8135
Mailing Address - Fax:
Practice Address - Street 1:530 LAKEHURST ROAD
Practice Address - Street 2:SUITE 206
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08755
Practice Address - Country:US
Practice Address - Phone:732-341-4733
Practice Address - Fax:432-341-2794
Is Sole Proprietor?:No
Enumeration Date:2005-12-08
Last Update Date:2020-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05932100207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6539700Medicaid
NJ6539700Medicaid
NJ741626NAQMedicare ID - Type Unspecified
F55032Medicare UPIN