Healthcare Provider Details

I. General information

NPI: 1063379576
Provider Name (Legal Business Name): MICHELLE L WINGATE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/07/2026
Last Update Date: 01/07/2026
Certification Date: 01/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 UNIVERSITY PLZ STE 301
HACKENSACK NJ
07601-6224
US

IV. Provider business mailing address

135 MOUNT PLEASANT AVE APT 1
WALLINGTON NJ
07057-2044
US

V. Phone/Fax

Practice location:
  • Phone: 201-975-5300
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SL06952000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: