Healthcare Provider Details

I. General information

NPI: 1821626961
Provider Name (Legal Business Name): DEREK JACOB WOLOSZYN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2020
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 MAIN ST STE 3
BEDMINSTER NJ
07921-2689
US

IV. Provider business mailing address

350 MAIN ST STE 3
BEDMINSTER NJ
07921-2689
US

V. Phone/Fax

Practice location:
  • Phone: 908-291-8099
  • Fax:
Mailing address:
  • Phone: 908-291-8099
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number25MS12729100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: