Provider Demographics
NPI:1235207986
Name:WATERS, WENDELYN LEE (MD)
Entity Type:Individual
Prefix:DR
First Name:WENDELYN
Middle Name:LEE
Last Name:WATERS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:149 OLD TURNPIKE RD
Mailing Address - Street 2:
Mailing Address - City:PORT MURRAY
Mailing Address - State:NJ
Mailing Address - Zip Code:07865-3216
Mailing Address - Country:US
Mailing Address - Phone:908-684-1182
Mailing Address - Fax:
Practice Address - Street 1:5 HASTINGS SQUARE MALL
Practice Address - Street 2:SCHOOLEY'S MOUNTAIN RD
Practice Address - City:HACKETTSTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07840-4227
Practice Address - Country:US
Practice Address - Phone:908-979-0050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA07479300207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine