MEDICARE: PANTHIP WOODEN REGISTERED NURSE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	26NR27509100	NJ

General Provider Information

NPI Number	:	1306709217
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PANTHIP WOODEN REGISTERED NURSE

Provider Business Mailing Address
First Line	:	290 KEMPSEY DR
Second Line	:
City	:	NORTH BRUNSWICK
State	:	NJ
Zip	:	08902-4224
Country	:	US
Telephone Number	:	848-893-5998
Fax Number	:

Provider Business Practice Location Address
First Line	:	290 KEMPSEY DR
Second Line	:
City	:	NORTH BRUNSWICK
State	:	NJ
Zip	:	08902-4224
Country	:	US
Telephone Number	:	848-893-5998
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/08/2025
Last Update Date	:	12/08/2025

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