Provider Demographics
NPI:1881166205
Name:WOJNICKI, STANLEY J
Entity type:Individual
Prefix:MR
First Name:STANLEY
Middle Name:J
Last Name:WOJNICKI
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:STANLEY
Other - Middle Name:J
Other - Last Name:WOJNICKI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN
Mailing Address - Street 1:28 TAMARACK LN
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:NY
Mailing Address - Zip Code:10970-2011
Mailing Address - Country:US
Mailing Address - Phone:845-354-6954
Mailing Address - Fax:
Practice Address - Street 1:99 WALL ST STE 1982
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10005-4301
Practice Address - Country:US
Practice Address - Phone:631-624-7449
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-24
Last Update Date:2021-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY685705163WC1500X
NY685705-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WC1500XNursing Service ProvidersRegistered NurseCommunity Health