Provider Demographics
NPI:1174671317
Name:OUW, WILLEM B (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLEM
Middle Name:B
Last Name:OUW
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 1:40 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07104-2530
Mailing Address - Country:US
Mailing Address - Phone:973-481-6057
Mailing Address - Fax:973-481-0106
Practice Address - Street 1:40 BROADWAY
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07104-2530
Practice Address - Country:US
Practice Address - Phone:973-481-6057
Practice Address - Fax:973-481-0106
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA043595174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJC54642Medicare UPIN