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General NPI Number Information
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NPI Number | 1700692001
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Entity Type | Individual
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Provider Name | JOHN WILDONGER
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Gender | Male
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Dates
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Enumeration Date | 12/10/2024
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Last Update Date | 12/10/2024
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Provider Practice Location Address
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Address Line | 2601 HOLME AVE
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City | PHILADELPHIA
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State | PA
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Zip | 19152-2007
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Country | US
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Telephone | 215-335-6000
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Fax |
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Provider Business Mailing Address
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Address Line | 1070 LAUREL HILL LN
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City | JENKINTOWN
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State | PA
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Zip | 19046-1162
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Country | US
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Telephone | 267-505-6796
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | RN732803
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License Number State | PA
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