Provider Demographics
NPI:1962826792
Name:OLEJNICZAK, CRAIG (MS, ATC)
Entity Type:Individual
Prefix:MR
First Name:CRAIG
Middle Name:
Last Name:OLEJNICZAK
Suffix:
Gender:M
Credentials:MS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61 JAYNE ST
Mailing Address - Street 2:
Mailing Address - City:FLORIDA
Mailing Address - State:NY
Mailing Address - Zip Code:10921-1108
Mailing Address - Country:US
Mailing Address - Phone:845-988-3030
Mailing Address - Fax:
Practice Address - Street 1:61 JAYNE ST
Practice Address - Street 2:
Practice Address - City:FLORIDA
Practice Address - State:NY
Practice Address - Zip Code:10921-1108
Practice Address - Country:US
Practice Address - Phone:845-988-3030
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-14
Last Update Date:2014-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000733-12255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer