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General NPI Number Information
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NPI Number | 1326272931
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Entity Type | Organization
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Legal Business Name | ISLAND CARE INC
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Dates
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Enumeration Date | 05/11/2009
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Last Update Date | 05/11/2009
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Provider Practice Location Address
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Address Line | 116 E 17TH AVE
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City | N WILDWOOD
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State | NJ
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Zip | 08260-5531
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Country | US
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Telephone | 818-482-3769
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Fax |
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Provider Business Mailing Address
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Address Line | 116 E 17TH AVE
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City | N WILDWOOD
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State | NJ
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Zip | 08260-5531
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Country | US
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Telephone | 818-482-3769
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | YOLANDA WADE
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Credential | MD
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Telephone | 818-482-3760
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 25MA 07023000
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License Number State | NJ
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