MEDICARE: DR. ANN M WRY MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	25MA06656300	NJ

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	159767	OTHER	NJ	MEDICARE PTAN

General Provider Information

NPI Number	:	1013964204
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANN M WRY MD

Provider Business Mailing Address
First Line	:	1360 CLIFTON AVE
Second Line	:	PMB 271
City	:	CLIFTON
State	:	NJ
Zip	:	07012-1343
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	114 ESSEX ST
Second Line	:
City	:	ROCHELLE PARK
State	:	NJ
Zip	:	07662-4335
Country	:	US
Telephone Number	:	201-368-0201
Fax Number	:	201-368-0346

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/31/2006
Last Update Date	:	12/27/2009

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Directions to “ DR. ANN M WRY MD” Practice Location

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