Provider Demographics
NPI: | 1962956029 |
---|---|
Name: | OLYMPIC CORPORATION |
Entity type: | Organization |
Organization Name: | OLYMPIC CORPORATION |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | PRESIDENT |
Authorized Official - Prefix: | |
Authorized Official - First Name: | JOSEPH |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | WAPENSKI |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | MD |
Authorized Official - Phone: | 412-369-9059 |
Mailing Address - Street 1: | 302 GRACE DEL LN |
Mailing Address - Street 2: | |
Mailing Address - City: | PITTSBURGH |
Mailing Address - State: | PA |
Mailing Address - Zip Code: | 15237-4300 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 412-369-9059 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 401 SMITH DR |
Practice Address - Street 2: | SUITE 4 |
Practice Address - City: | CRANBERRY TWP |
Practice Address - State: | PA |
Practice Address - Zip Code: | 16066-4140 |
Practice Address - Country: | US |
Practice Address - Phone: | 724-772-7080 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2016-08-06 |
Last Update Date: | 2016-08-06 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
PA | MD044065E | 2084N0400X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 2084N0400X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology | Group - Single Specialty |