Provider Demographics
NPI:1881624856
Name:OLENGINSKI, MICHAEL A (DO)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:A
Last Name:OLENGINSKI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:423 3RD AVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:KINGSTON
Mailing Address - State:PA
Mailing Address - Zip Code:18704-5809
Mailing Address - Country:US
Mailing Address - Phone:570-714-3434
Mailing Address - Fax:570-714-6355
Practice Address - Street 1:423 3RD AVE
Practice Address - Street 2:SUITE C
Practice Address - City:KINGSTON
Practice Address - State:PA
Practice Address - Zip Code:18704-5809
Practice Address - Country:US
Practice Address - Phone:570-714-3434
Practice Address - Fax:570-714-6355
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2008-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS006897L207Y00000X, 207YX0602X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No207YX0602XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngic Allergy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA078612OtherFIRST PRIORITY HEALTH
PA0012408070004Medicaid
PA078612OtherFIRST PRIORITY HEALTH
PA665872J5GMedicare ID - Type Unspecified