Provider Demographics
NPI:1134164874
Name:WIANECKA, ALEKSANDRA A (OD)
Entity type:Individual
Prefix:DR
First Name:ALEKSANDRA
Middle Name:A
Last Name:WIANECKA
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:66 DEER PARK AVE
Mailing Address - Street 2:
Mailing Address - City:BABYLON
Mailing Address - State:NY
Mailing Address - Zip Code:11702-2802
Mailing Address - Country:US
Mailing Address - Phone:631-789-6103
Mailing Address - Fax:631-789-6103
Practice Address - Street 1:66 DEER PARK AVE
Practice Address - Street 2:
Practice Address - City:BABYLON
Practice Address - State:NY
Practice Address - Zip Code:11702-2802
Practice Address - Country:US
Practice Address - Phone:631-789-6103
Practice Address - Fax:631-789-6105
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-17
Last Update Date:2022-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYT006534152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY7077519OtherAETNA
NYC337F1OtherEMPIRE BC.BS
NYC220G1Medicare ID - Type Unspecified
NYC337F1OtherEMPIRE BC.BS