1083809859 NPI number — WENDY LYNN POLHEMUS

Table of content: DR. OCEANA RAMES NMD (NPI 1992888747)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083809859 NPI number — WENDY LYNN POLHEMUS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WENDY LYNN POLHEMUS
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:
Provider Other Organization Name Type Code:
6
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:
1083809859
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/27/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
21 BROADWAY
Provider Second Line Business Mailing Address:
SUITE E
Provider Business Mailing Address City Name:
WOODCLIFF LAKE
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07677-8058
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
201-505-0001
Provider Business Mailing Address Fax Number:
201-505-4844

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
21 BROADWAY
Provider Second Line Business Practice Location Address:
SUITE E
Provider Business Practice Location Address City Name:
WOODCLIFF LAKE
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07677-8058
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
201-505-0001
Provider Business Practice Location Address Fax Number:
201-505-4844
Provider Enumeration Date:
09/13/2007

Additional Information

Authorized Official

Authorized Official Last Name:
POLHEMUS
Authorized Official First Name:
WENDI
Authorized Official Middle Name:
LYNN
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
201-505-0001

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  38MC00498100 , 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: 1831261585 . This is a "INDIVIDUAL NPI" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




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