Healthcare Provider Details

I. General information

NPI: 1659900934
Provider Name (Legal Business Name): REBECCA WILDING
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2020
Last Update Date: 03/09/2026
Certification Date: 03/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2840 MORRIS AVE
UNION NJ
07083-4851
US

IV. Provider business mailing address

2840 MORRIS AVE
UNION NJ
07083-4851
US

V. Phone/Fax

Practice location:
  • Phone: 888-244-5373
  • Fax: 908-686-3024
Mailing address:
  • Phone: 888-244-5373
  • Fax: 908-686-3024

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P0010X
TaxonomyPediatric Rehabilitation Medicine Physician
License Number25MB12801600
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number25MB12801600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: