Provider Demographics
NPI:1114995941
Name:WILDMAN, JOSEPH M (MD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:M
Last Name:WILDMAN
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 1:65 E NORTHFIELD RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:LIVINGSTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07039-4525
Mailing Address - Country:US
Mailing Address - Phone:973-422-0023
Mailing Address - Fax:973-422-0033
Practice Address - Street 1:65 E NORTHFIELD RD
Practice Address - Street 2:SUITE A
Practice Address - City:LIVINGSTON
Practice Address - State:NJ
Practice Address - Zip Code:07039-4525
Practice Address - Country:US
Practice Address - Phone:973-422-0023
Practice Address - Fax:973-422-0033
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2016-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA33530207RH0003X
NJ25MA03353000207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ032405BSDMedicare ID - Type Unspecified
NJE53410Medicare UPIN
E35410Medicare UPIN