Healthcare Provider Details

I. General information

NPI: 1184879157
Provider Name (Legal Business Name): WAYNE MEDICAL ASSOCIATES,P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/18/2008
Last Update Date: 01/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2025 HAMBURG TPKE STE D
WAYNE NJ
07470-6250
US

IV. Provider business mailing address

2025 HAMBURG TPKE STE D
WAYNE NJ
07470-6250
US

V. Phone/Fax

Practice location:
  • Phone: 973-839-5070
  • Fax:
Mailing address:
  • Phone: 973-839-5070
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. RICHARD H. BERKOWITZ
Title or Position: PRESIDENT
Credential: M.D.
Phone: 973-839-5070