Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QS0010X | Family Doctor - Sports Medicine | 25MA08837900 | NJ |
N | 2081S0010X | Sports Medicine | 25MA08837900 | NJ |
N | 213ES0000X | Sports Medicine | 25MA08837900 | NJ |
NPI | 1396066627 |
---|---|
Provider Name | Dr. Peter Christopher Wenger |
First Address | Lawrenceville, NJ 08648-2201 |
Second Address | Lawrenceville, NJ 08648-2201 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/06/2010 |
Last Update Date | 27/06/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
175461 | AIUM ULTRASOUND ACCREDITATION (01) | NJ |