Healthcare Provider Details

I. General information

NPI: 1245561232
Provider Name (Legal Business Name): WIW MEDICAL ASSOCIATES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/15/2010
Last Update Date: 12/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

290 LAFAYETTE AVE
HAWTHORNE NJ
07506-1961
US

IV. Provider business mailing address

297 LAFAYETTE AVE
HAWTHORNE NJ
07506-1919
US

V. Phone/Fax

Practice location:
  • Phone: 973-839-1003
  • Fax: 973-839-3653
Mailing address:
  • Phone: 973-839-1003
  • Fax: 973-839-3653

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number25MA03176700
License Number StateNJ

VIII. Authorized Official

Name: JOHN STROBECK
Title or Position: OWNER
Credential: MD
Phone: 973-839-1003