Provider Demographics
NPI:1205934940
Name:WOLCZYNSKI, ZBIGNIEW (MD)
Entity type:Individual
Prefix:
First Name:ZBIGNIEW
Middle Name:
Last Name:WOLCZYNSKI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 CORNELIA ST
Mailing Address - Street 2:SUITE 404
Mailing Address - City:PLATTSBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12901-2318
Mailing Address - Country:US
Mailing Address - Phone:518-562-7337
Mailing Address - Fax:518-562-7338
Practice Address - Street 1:210 CORNELIA ST
Practice Address - Street 2:SUITE 404
Practice Address - City:PLATTSBURGH
Practice Address - State:NY
Practice Address - Zip Code:12901-2318
Practice Address - Country:US
Practice Address - Phone:518-562-7337
Practice Address - Fax:518-562-7338
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2013-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY223338207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0007505490OtherAETNA
NY02301435Medicaid
NY252AA1OtherEMPIRE BC/BS
NYP010223338OtherEXCELLUS BCBS
NY201726511 12901 A001OtherTRICARE
NY10084802OtherCDPHP
NY000402772002OtherBSNENY
NM200059037OtherMVP
NY000402772002OtherBSNENY
NYP010223338OtherEXCELLUS BCBS