Provider Demographics
NPI:1811963879
Name:MOJICA, WILFRIDO D (MD)
Entity type:Individual
Prefix:
First Name:WILFRIDO
Middle Name:D
Last Name:MOJICA
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 1:310 STERLING DR
Mailing Address - Street 2:
Mailing Address - City:ORCHARD PARK
Mailing Address - State:NY
Mailing Address - Zip Code:14127-1500
Mailing Address - Country:US
Mailing Address - Phone:716-689-1901
Mailing Address - Fax:
Practice Address - Street 1:310 STERLING DR
Practice Address - Street 2:
Practice Address - City:ORCHARD PARK
Practice Address - State:NY
Practice Address - Zip Code:14127-1500
Practice Address - Country:US
Practice Address - Phone:716-677-9220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-28
Last Update Date:2019-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY215726-1207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYCC5819Medicare ID - Type Unspecified
NYH09749Medicare UPIN