Provider Demographics
NPI:1912998063
Name:WOJCIK, COLLEEN M (NP)
Entity Type:Individual
Prefix:MRS
First Name:COLLEEN
Middle Name:M
Last Name:WOJCIK
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1617 N JAMES ST
Mailing Address - Street 2:STE 400
Mailing Address - City:ROME
Mailing Address - State:NY
Mailing Address - Zip Code:13440
Mailing Address - Country:US
Mailing Address - Phone:315-337-0539
Mailing Address - Fax:315-337-0645
Practice Address - Street 1:91 PERIMETER RD STE 120
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:NY
Practice Address - Zip Code:13441-4018
Practice Address - Country:US
Practice Address - Phone:315-337-0539
Practice Address - Fax:315-337-0645
Is Sole Proprietor?:No
Enumeration Date:2005-10-28
Last Update Date:2021-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF302953363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02329142Medicaid
NY392162OtherMVP
040212601448OtherFIDELIS
DD7111Medicare ID - Type Unspecified
040212601448OtherFIDELIS