Healthcare Provider Details

I. General information

NPI: 1073511085
Provider Name (Legal Business Name): DR. FRED WOLODIGER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2005
Last Update Date: 04/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

375 ENGLE ST
ENGLEWOOD NJ
07631-1823
US

IV. Provider business mailing address

375 ENGLE ST
ENGLEWOOD NJ
07631-1823
US

V. Phone/Fax

Practice location:
  • Phone: 201-894-0400
  • Fax: 201-894-1022
Mailing address:
  • Phone: 201-894-0400
  • Fax: 201-894-1022

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number25MA04623100
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number25MA04623100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: