Healthcare Provider Details

I. General information

NPI: 1023169455
Provider Name (Legal Business Name): CRAIG M. WAX, DO, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/13/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 N MAIN ST
MULLICA HILL NJ
08062-2612
US

IV. Provider business mailing address

155 N MAIN ST
MULLICA HILL NJ
08062-2612
US

V. Phone/Fax

Practice location:
  • Phone: 856-478-4780
  • Fax: 856-478-0789
Mailing address:
  • Phone: 856-478-4780
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMB62553
License Number StateNJ

VIII. Authorized Official

Name: DR. CRAIG M WAX
Title or Position: MEDICAL DIRECTOR
Credential: DO
Phone: 856-478-4780