Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 25MA04623100 | NJ |
Y | 208600000X | Surgeon | 25MA04623100 | NJ |
N | 2086S0129X | Vascular Surgeon | 25MA04623100 | NJ |
NPI | 1073511085 |
---|---|
Provider Name | Dr. Fred Wolodiger |
First Address | Englewood, NJ 07631-1823 |
Second Address | Englewood, NJ 07631-1823 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/07/2005 |
Last Update Date | 09/04/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0486205 | (05) | NJ |
330001882 | RAILROAD MEDICARE ID # (01) | NJ |
C53764 | (02) | NJ |