Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RC0000X | Internist - Cardiovascular Disease | 25MA08328000 | NJ |
NPI | 1013112671 |
---|---|
Provider Name | Dr. David Marc Wild |
First Address | Teaneck, NJ 07666-4504 |
Second Address | Teaneck, NJ 07666-4504 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/06/2007 |
Last Update Date | 12/07/2016 |