Provider Demographics
NPI:1790027407
Name:RON L. WAWRZYNIAK D.C. P.A.
Entity Type:Organization
Organization Name:RON L. WAWRZYNIAK D.C. P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RON
Authorized Official - Middle Name:
Authorized Official - Last Name:WAWRZYNIAK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:908-722-0500
Mailing Address - Street 1:32 ROOSEVELT PLACE
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08876
Mailing Address - Country:US
Mailing Address - Phone:908-722-0500
Mailing Address - Fax:
Practice Address - Street 1:32 ROOSEVELT PLACE
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08876
Practice Address - Country:US
Practice Address - Phone:908-722-0500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-20
Last Update Date:2013-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00322700261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJT45674Medicare UPIN