Provider Demographics
NPI:1205632403
Name:WOJOWECZ, MADISON
Entity type:Individual
Prefix:
First Name:MADISON
Middle Name:
Last Name:WOJOWECZ
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:73 A TROY RD
Mailing Address - Street 2:UNIT 2 FIRST FLOOR
Mailing Address - City:EAST GREENBUSH
Mailing Address - State:NY
Mailing Address - Zip Code:12061
Mailing Address - Country:US
Mailing Address - Phone:518-449-1142
Mailing Address - Fax:
Practice Address - Street 1:73 A TROY RD
Practice Address - Street 2:UNIT 2 FIRST FLOOR
Practice Address - City:EAST GREENBUSH
Practice Address - State:NY
Practice Address - Zip Code:12061
Practice Address - Country:US
Practice Address - Phone:518-449-1142
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-20
Last Update Date:2025-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY945869163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse