Basic Information
| Provider Information | |||||||||
| NPI: | 1164405585 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | WOJCIK | ||||||||
| FirstName: | JAN | ||||||||
| MiddleName: | B | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | TRINITY HEALTH OF NE MED GRP - ATTN: PGREANEY | ||||||||
| Address2: | 395 SOUTHAMPTON RD #100 | ||||||||
| City: | WESTFIELD | ||||||||
| State: | MA | ||||||||
| PostalCode: | 010851324 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4134854663 | ||||||||
| FaxNumber: | 4135621605 | ||||||||
| Practice Location | |||||||||
| Address1: | 175 CAREW STREET | ||||||||
| Address2: | SUITE 110 | ||||||||
| City: | SPRINGFIELD | ||||||||
| State: | MA | ||||||||
| PostalCode: | 01104 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4137324269 | ||||||||
| FaxNumber: | 4137854619 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/21/2005 | ||||||||
| LastUpdateDate: | 10/11/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208C00000X | 72523 | MA | Y | Allopathic & Osteopathic Physicians | Colon & Rectal Surgery |
ID Information
| ID | Type | State | Issuer | Description | 62128335 | 05 | MA | MEDICAID |