MEDICARE: PAUL WENZEL

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	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1538701438
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAUL WENZEL

Provider Business Mailing Address
First Line	:	2383 CROSSING WAY
Second Line	:
City	:	WAYNE
State	:	NJ
Zip	:	07470-4734
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	771 BLOOMFIELD AVE
Second Line	:
City	:	WEST CALDWELL
State	:	NJ
Zip	:	07006-6701
Country	:	US
Telephone Number	:	973-521-5554
Fax Number	:

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

Provider Enumeration Date	:	10/11/2019
Last Update Date	:	10/11/2019

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Directions to “ PAUL WENZEL ” Practice Location

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