Provider Demographics
NPI:1811972748
Name:WAWRZYNIAK, ROMUALD L (DC)
Entity type:Individual
Prefix:DR
First Name:ROMUALD
Middle Name:L
Last Name:WAWRZYNIAK
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 ROOSEVELT PL
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08876-2010
Mailing Address - Country:US
Mailing Address - Phone:908-722-0500
Mailing Address - Fax:908-722-7388
Practice Address - Street 1:32 ROOSEVELT PL
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08876-2010
Practice Address - Country:US
Practice Address - Phone:908-722-0500
Practice Address - Fax:908-722-7388
Is Sole Proprietor?:No
Enumeration Date:2005-12-14
Last Update Date:2013-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00322700111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3360407Medicaid
NJ3360407Medicaid
NJWA520376Medicare ID - Type Unspecified