Provider Demographics
NPI:1033892385
Name:WOLVERS, MARINUS
Entity Type:Individual
Prefix:
First Name:MARINUS
Middle Name:
Last Name:WOLVERS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2025 LINCOLN HWY STE 150
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08817-3393
Mailing Address - Country:US
Mailing Address - Phone:732-243-9669
Mailing Address - Fax:732-243-9673
Practice Address - Street 1:2025 LINCOLN HWY STE 150
Practice Address - Street 2:
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08817-3393
Practice Address - Country:US
Practice Address - Phone:732-243-9669
Practice Address - Fax:732-243-9673
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-11
Last Update Date:2023-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJHP0352600251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health