Provider Demographics
NPI:1801783790
Name:WOJTENKO, LARISSA (PA)
Entity type:Individual
Prefix:MS
First Name:LARISSA
Middle Name:
Last Name:WOJTENKO
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1007 MANTUA PIKE STE 2
Mailing Address - Street 2:
Mailing Address - City:WEST DEPTFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:08096-3963
Mailing Address - Country:US
Mailing Address - Phone:856-853-8004
Mailing Address - Fax:856-853-4654
Practice Address - Street 1:1007 MANTUA PIKE STE 2
Practice Address - Street 2:
Practice Address - City:WEST DEPTFORD
Practice Address - State:NJ
Practice Address - Zip Code:08096-3963
Practice Address - Country:US
Practice Address - Phone:856-853-8004
Practice Address - Fax:856-856-4654
Is Sole Proprietor?:No
Enumeration Date:2025-06-23
Last Update Date:2025-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00938600207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1750426151OtherNPI