Provider Demographics
NPI:1962893834
Name:WASIUK, ANTHONY AIME (BC-HIS)
Entity type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:AIME
Last Name:WASIUK
Suffix:
Gender:M
Credentials:BC-HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:52 WEST ST
Mailing Address - Street 2:
Mailing Address - City:LEOMINSTER
Mailing Address - State:MA
Mailing Address - Zip Code:01453-5654
Mailing Address - Country:US
Mailing Address - Phone:978-534-4994
Mailing Address - Fax:978-466-6603
Practice Address - Street 1:52 WEST ST
Practice Address - Street 2:
Practice Address - City:LEOMINSTER
Practice Address - State:MA
Practice Address - Zip Code:01453-5654
Practice Address - Country:US
Practice Address - Phone:978-534-4994
Practice Address - Fax:978-466-6603
Is Sole Proprietor?:No
Enumeration Date:2015-02-12
Last Update Date:2015-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA62237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1235282070Medicaid