Healthcare Provider Details

I. General information

NPI: 1639310725
Provider Name (Legal Business Name): BARBARA WYCZESANY NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/18/2009
Last Update Date: 03/18/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 PERRINE RD SUITE 211
OLD BRIDGE NJ
08857-2842
US

IV. Provider business mailing address

1008 AUMACK RD
JACKSON NJ
08527-1389
US

V. Phone/Fax

Practice location:
  • Phone: 732-553-1000
  • Fax:
Mailing address:
  • Phone: 732-942-8530
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number26NJ00183200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: