1982754800 NPI number — CRAIG WEXLER, D.P.M. P C

Table of content: (NPI 1982754800)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982754800 NPI number — CRAIG WEXLER, D.P.M. P C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CRAIG WEXLER, D.P.M. P C
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
WEXLER FOOT CENTER
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1982754800
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/25/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
125 NEWTON SPARTA RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEWTON
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07860-2769
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
973-383-3115
Provider Business Mailing Address Fax Number:
973-383-3201

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
125 NEWTON SPARTA RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEWTON
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07860-2769
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-383-3115
Provider Business Practice Location Address Fax Number:
973-383-3201
Provider Enumeration Date:
01/11/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SLOTTER
Authorized Official First Name:
WILLIAM
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
973-383-3115

Provider Taxonomy Codes

  • Taxonomy code: 213ES0103X , with the licence number:  00201600 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1285613604 . This is a "NPI INDIVIDUAL NUMBER" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 0104370 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".




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