Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0131X | Foot Surgery | 25MD00117000 | NJ |
NPI | 1164473112 |
---|---|
Provider Name | Dr. Steven Alan Wahl |
First Address | Roseland, NJ 07068-3731 |
Second Address | Roseland, NJ 07068-3731 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/05/2006 |
Last Update Date | 08/07/2007 |