Healthcare Provider Details

I. General information

NPI: 1902951890
Provider Name (Legal Business Name): MARTIN EDMUND WENDELKEN JR. DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/24/2007
Last Update Date: 01/06/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1740 EASTCHESTER RD CENTER FOR PALLIATIVE WOUND CARE
BRONX NY
10461-2300
US

IV. Provider business mailing address

610 BOULEVARD
ELMWOOD PARK NJ
07407-1343
US

V. Phone/Fax

Practice location:
  • Phone: 646-220-1745
  • Fax:
Mailing address:
  • Phone: 646-220-1745
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License NumberN004003
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: