Provider Demographics
NPI:1215025440
Name:HURST, WENDY R (MD, FACOG)
Entity Type:Individual
Prefix:DR
First Name:WENDY
Middle Name:R
Last Name:HURST
Suffix:
Gender:F
Credentials:MD, FACOG
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:370 GRAND AVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:ENGLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07631-4154
Mailing Address - Country:US
Mailing Address - Phone:201-894-9599
Mailing Address - Fax:201-894-9192
Practice Address - Street 1:370 GRAND AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:ENGLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07631-4154
Practice Address - Country:US
Practice Address - Phone:201-894-9599
Practice Address - Fax:201-894-9192
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA55257173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173000000XOther Service ProvidersLegal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJE76693Medicare UPIN
NJ660503Medicare ID - Type Unspecified