Provider Demographics
NPI:1033128921
Name:WURMSER, ERIC A (MD)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:A
Last Name:WURMSER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 HIGHWAY 35 NORTH
Mailing Address - Street 2:SUITE 102
Mailing Address - City:RED BANK
Mailing Address - State:NJ
Mailing Address - Zip Code:07701
Mailing Address - Country:US
Mailing Address - Phone:732-747-5353
Mailing Address - Fax:732-747-5535
Practice Address - Street 1:225 HIGHWAY 35 NORTH
Practice Address - Street 2:SUITE 102
Practice Address - City:RED BANK
Practice Address - State:NJ
Practice Address - Zip Code:07701
Practice Address - Country:US
Practice Address - Phone:732-747-5353
Practice Address - Fax:732-747-5535
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-07
Last Update Date:2008-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA031417208200000X
NJ25MA03141700208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
C56786Medicare UPIN
NJ520882U4SMedicare ID - Type Unspecified