Basic Information
| Provider Information | |||||||||
| NPI: | 1508882267 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WOJTCZAK | ||||||||
| FirstName: | JACEK | ||||||||
| MiddleName: | A | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 601 ELMWOOD AVE | ||||||||
| Address2: | BOX 604 | ||||||||
| City: | ROCHESTER | ||||||||
| State: | NY | ||||||||
| PostalCode: | 146420001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5852755982 | ||||||||
| FaxNumber: | 5857560169 | ||||||||
| Practice Location | |||||||||
| Address1: | 601 ELMWOOD AVE | ||||||||
| Address2: | BOX 604 | ||||||||
| City: | ROCHESTER | ||||||||
| State: | NY | ||||||||
| PostalCode: | 146420001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5852755982 | ||||||||
| FaxNumber: | 5857560169 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/14/2006 | ||||||||
| LastUpdateDate: | 07/09/2007 | ||||||||
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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 | 207L00000X | 183472 | NY | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | MDA522 | 01 | NY | PREFERRED CARE | OTHER | 5052693 | 01 | NY | AETNA | OTHER | 000912474001 | 01 | NY | BS WNY/HEALTHNOW | OTHER | G0189393590 | 01 | NY | BLUE CHOICE GROUP | OTHER | 00040770801 | 01 | NY | UNIVERA | OTHER | 183472-0 | 01 | NY | WORKER'S COMP | OTHER | 2101250 | 01 | NY | GHI | OTHER | 965779 | 01 | NY | MVP PROVIDER | OTHER | 2222 | 01 | NY | BLUE SHIELD | OTHER | 01260824 | 05 | NY | MEDICAID |