Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208800000X | Urologist | 240026 | NY |
Y | 208800000X | Urologist | 25MA10611400 | NJ |
N | 208800000X | Urologist | 4301086135 | MI |
N | 208800000X | Urologist | BW9323382 | NJ |
NPI | 1023090230 |
---|---|
Provider Name | Dr. Jason B. Wynberg |
First Address | Philadelphia, PA 19195-4480 |
Second Address | Denville, NJ 07834 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/11/2005 |
Last Update Date | 30/06/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
02759039 | (05) | NY |
I35111 | (02) | |
I35111 | (02) | NY |
P1388005 | OXFORD (01) | NJ |
PENDING | (05) | NJ |