Provider Demographics
NPI:1154045375
Name:WASIELEWSKI, WOJCIECH R (LMT)
Entity type:Individual
Prefix:
First Name:WOJCIECH
Middle Name:R
Last Name:WASIELEWSKI
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:54 HENRY ST FL 2
Mailing Address - Street 2:
Mailing Address - City:HALEDON
Mailing Address - State:NJ
Mailing Address - Zip Code:07508-1455
Mailing Address - Country:US
Mailing Address - Phone:929-288-5028
Mailing Address - Fax:
Practice Address - Street 1:54 HENRY ST FL 2
Practice Address - Street 2:
Practice Address - City:HALEDON
Practice Address - State:NJ
Practice Address - Zip Code:07508-1455
Practice Address - Country:US
Practice Address - Phone:929-288-5028
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-30
Last Update Date:2022-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ18KT01446200225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist