Individual
JOHN WACENDAK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
40 ARCH ST, JOHNSON CITY, NY 13790-2102
(607) 763-6075
Mailing address
346 GRAND AVE, JOHNSON CITY, NY 13790-2558
(607) 770-0025
(607) 729-3982
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
194762
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01565544
—
NY
Enumeration date
10/03/2005
Last updated
11/19/2011
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