=====================================================
General NPI Number Information
=====================================================
NPI Number | 1477796613
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | WENDY ROBIN WISHNICK AUD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/17/2009
-----------------------------------------------------
Last Update Date | 08/04/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1131 BROAD ST SUITE 103
-----------------------------------------------------
City | SHREWSBURY
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07702-4329
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-460-1494
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1131 BROAD ST SUITE 103
-----------------------------------------------------
City | SHREWSBURY
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07702-4329
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-460-1494
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 231H00000X
-----------------------------------------------------
Taxonomy Name | Audiologist
-----------------------------------------------------
License Number | 41YA00005200
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------