Basic Information
| Provider Information | |||||||||
| NPI: | 1548432164 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MARK WAYNIK MD LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 52 BEACH RD | ||||||||
| Address2: | SUITE 104 | ||||||||
| City: | FAIRFIELD | ||||||||
| State: | CT | ||||||||
| PostalCode: | 06824 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2032542000 | ||||||||
| FaxNumber: | 2032553126 | ||||||||
| Practice Location | |||||||||
| Address1: | 52 BEACH RD | ||||||||
| Address2: | SUITE 104 | ||||||||
| City: | FAIRFIELD | ||||||||
| State: | CT | ||||||||
| PostalCode: | 06824 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2032542000 | ||||||||
| FaxNumber: | 2032553126 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/25/2008 | ||||||||
| LastUpdateDate: | 03/25/2008 | ||||||||
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| AuthorizedOfficialLastName: | WAYNIK | ||||||||
| AuthorizedOfficialFirstName: | MARK | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 2032542000 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | 024277 | CT | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
No ID Information.