Provider Demographics
NPI:1962556126
Name:OLEJAK, JOSEPH V (DL)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:V
Last Name:OLEJAK
Suffix:
Gender:M
Credentials:DL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:323 DELAWARE AVE
Mailing Address - Street 2:
Mailing Address - City:DELMAR
Mailing Address - State:NY
Mailing Address - Zip Code:12054
Mailing Address - Country:US
Mailing Address - Phone:518-439-5077
Mailing Address - Fax:518-439-8489
Practice Address - Street 1:323 DELAWARE AVE
Practice Address - Street 2:
Practice Address - City:DELMAR
Practice Address - State:NY
Practice Address - Zip Code:12054
Practice Address - Country:US
Practice Address - Phone:518-439-5077
Practice Address - Fax:518-439-8489
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX006011111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
U06048Medicare UPIN