Healthcare Provider Details

I. General information

NPI: 1730207531
Provider Name (Legal Business Name): WENDY V WARNER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 FRANKLIN TPKE
RIDGEWOOD NJ
07450-1932
US

IV. Provider business mailing address

4 REVERE CT APT. 2111
SUFFERN NY
10901-7438
US

V. Phone/Fax

Practice location:
  • Phone: 201-447-1900
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number46TA09049900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: