1982610010 NPI number — DR. JOSEPH WENDOLOWSKI DPM

Table of content: DR. JOSEPH WENDOLOWSKI DPM (NPI 1982610010)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982610010 NPI number — DR. JOSEPH WENDOLOWSKI DPM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WENDOLOWSKI
Provider First Name:
JOSEPH
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DPM
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
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:
1982610010
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/06/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
17425 OCEAN ONE PLZ UNIT 1
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LEWES
Provider Business Mailing Address State Name:
DE
Provider Business Mailing Address Postal Code:
19958-1726
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
302-297-8431
Provider Business Mailing Address Fax Number:
302-433-6547

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
17425 OCEAN ONE PLZ UNIT 1
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEWES
Provider Business Practice Location Address State Name:
DE
Provider Business Practice Location Address Postal Code:
19958
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
302-297-8431
Provider Business Practice Location Address Fax Number:
302-433-6547
Provider Enumeration Date:
07/31/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 213E00000X , with the licence number:  E1-0000243 , registered in the state of DE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 3325407 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".