Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 38MC00347800 | NJ |
N | 111NI0013X | Independent Medical Examiner | 38MC00347800 | NJ |
NPI | 1821315920 |
---|---|
Provider Name | Dr. John M Wolkstein |
First Address | West Orange, NJ 07052-2956 |
Second Address | West Orange, NJ 07052-2956 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/04/2010 |
Last Update Date | 28/04/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
222870224 | WORKERS COMENSATION, PIP (01) | NJ |