Provider Demographics
NPI:1912531286
Name:SAMUEL S WOOCIKER DPM PA
Entity type:Organization
Organization Name:SAMUEL S WOOCIKER DPM PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:S
Authorized Official - Last Name:WOOCIKER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:407-376-0522
Mailing Address - Street 1:445 WARRIOR TRL
Mailing Address - Street 2:
Mailing Address - City:ENTERPRISE
Mailing Address - State:FL
Mailing Address - Zip Code:32725-2456
Mailing Address - Country:US
Mailing Address - Phone:407-376-0522
Mailing Address - Fax:
Practice Address - Street 1:445 WARRIOR TRL
Practice Address - Street 2:
Practice Address - City:ENTERPRISE
Practice Address - State:FL
Practice Address - Zip Code:32725-2456
Practice Address - Country:US
Practice Address - Phone:407-376-0522
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-26
Last Update Date:2020-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Single Specialty