Provider Demographics
NPI:1184665382
Name:OLEJNICZAK, THOMAS JOHN (CRNA)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:JOHN
Last Name:OLEJNICZAK
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4185 SENECA STREET
Mailing Address - Street 2:SUITE 11
Mailing Address - City:WEST SENECA
Mailing Address - State:NY
Mailing Address - Zip Code:14224
Mailing Address - Country:US
Mailing Address - Phone:716-674-8189
Mailing Address - Fax:716-712-0469
Practice Address - Street 1:529 CENTRAL AVE
Practice Address - Street 2:BROOKS MEMORIAL HOSPITAL
Practice Address - City:DUNKIRK
Practice Address - State:NY
Practice Address - Zip Code:14048
Practice Address - Country:US
Practice Address - Phone:716-366-1111
Practice Address - Fax:716-363-7288
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3311011367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
BB3303Medicare ID - Type Unspecified