Provider Demographics
NPI:1326272931
Name:ISLAND CARE INC
Entity Type:Organization
Organization Name:ISLAND CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:YOLANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:WADE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-482-3760
Mailing Address - Street 1:116 E 17TH AVE
Mailing Address - Street 2:
Mailing Address - City:N WILDWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08260-5531
Mailing Address - Country:US
Mailing Address - Phone:818-482-3769
Mailing Address - Fax:
Practice Address - Street 1:116 E 17TH AVE
Practice Address - Street 2:
Practice Address - City:N WILDWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08260-5531
Practice Address - Country:US
Practice Address - Phone:818-482-3769
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-11
Last Update Date:2009-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA 07023000207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty