Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208100000X | Physical Medicine & Rehabilitation Doctor | 059349 | GA |
N | 208100000X | Physical Medicine & Rehabilitation Doctor | M2869 | TX |
Y | 2081P2900X | Pain Medicine | 25MA08436100 | NJ |
NPI | 1336327279 |
---|---|
Provider Name | Dr. Matthias Heinz Wiederholz |
First Address | Lawrenceville, NJ 08648-4779 |
Second Address | Lawrenceville, NJ 08648-4779 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/02/2008 |
Last Update Date | 30/03/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
135896STY | (02) | NJ |