Healthcare Provider Details

I. General information

NPI: 1851283162
Provider Name (Legal Business Name): HEATHER WOLAK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/21/2025
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1140 BLACK OAK RIDGE RD
WAYNE NJ
07470-6347
US

IV. Provider business mailing address

24 STONE HILL RD
RANDOLPH NJ
07869-2609
US

V. Phone/Fax

Practice location:
  • Phone: 201-572-8883
  • Fax: 201-572-8883
Mailing address:
  • Phone: 201-572-8883
  • Fax: 201-572-8883

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number26NJ15609800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: