# JOHN J. WASNIEWSKI JR. DO PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1427188937
- **Authorized official:** DR. JOHN JOSEPH WASNIEWSKI DO (PRESIDENT)
- **Authorized official phone:** (215) 271-0101

## Contact information

- **Practice address:** 2136 W PASSYUNK AVE, PHILADELPHIA, PA 19145-3415
- **Practice address phone:** (215) 271-0101
- **Practice address fax:** (215) 334-7259
- **Mailing address:** 2136 W PASSYUNK AVE, PHILADELPHIA, PA 19145-3415
- **Mailing address phone:** (215) 271-0101
- **Mailing address fax:** (215) 334-7259

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 03/06/2007
- **Last updated:** 03/27/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 0005923960004 | — | PA |
| 01 | — | 107718 | MEDICARE ID | PA |
| 01 | — | 1598762402 | NPI PRIVATE PROVIDER | PA |