Healthcare Provider Details

I. General information

NPI: 1598802761
Provider Name (Legal Business Name): ROBERT BOYD WISE DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

332 NORTH AVENUE
GARWOOD NJ
07027
US

IV. Provider business mailing address

332 NORTH AVENUE
GARWOOD NJ
07027
US

V. Phone/Fax

Practice location:
  • Phone: 908-789-2303
  • Fax: 908-789-2304
Mailing address:
  • Phone: 908-789-2303
  • Fax: 908-789-2304

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1996NJ
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: