Healthcare Provider Details

I. General information

NPI: 1063441566
Provider Name (Legal Business Name): DAVID WURTZEL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1030 KINGS HWY N
CHERRY HILL NJ
08034-1907
US

IV. Provider business mailing address

219 COUNTRYSIDE LN
MOUNT LAUREL NJ
08054-1023
US

V. Phone/Fax

Practice location:
  • Phone: 856-779-7774
  • Fax: 856-779-7787
Mailing address:
  • Phone: 856-722-1053
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number25MA04422400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: