1518028307 NPI number — WENDY T SHERTZ-DIPIETRO MD

Table of content: WENDY T SHERTZ-DIPIETRO MD (NPI 1518028307)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518028307 NPI number — WENDY T SHERTZ-DIPIETRO MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SHERTZ-DIPIETRO
Provider First Name:
WENDY
Provider Middle Name:
T
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DIPIETRO
Provider Other First Name:
WENDY
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1518028307
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/05/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 417
Provider Second Line Business Mailing Address:
279 THIRD AVENUE SUITE 104
Provider Business Mailing Address City Name:
LONG BRANCH
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07740
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
732-229-8711
Provider Business Mailing Address Fax Number:
732-229-0245

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
300 SECOND AVENUE
Provider Second Line Business Practice Location Address:
MONMOUTH MEDICAL CENTER DEPT OF PATHOLOGY
Provider Business Practice Location Address City Name:
LONG BRANCH
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07740
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
732-229-8711
Provider Business Practice Location Address Fax Number:
732-229-0245
Provider Enumeration Date:
12/13/2006

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: 207ZP0102X , with the licence number:  25MA04831900 , 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: 2309602 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com