Provider Demographics
NPI:1396843280
Name:DAVID, WENDY FAITH (DPM)
Entity Type:Individual
Prefix:DR
First Name:WENDY
Middle Name:FAITH
Last Name:DAVID
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:297 WESTWOOD DR
Mailing Address - Street 2:SUITE 106
Mailing Address - City:WOODBURY
Mailing Address - State:NJ
Mailing Address - Zip Code:08096-3144
Mailing Address - Country:US
Mailing Address - Phone:856-848-6262
Mailing Address - Fax:
Practice Address - Street 1:297 WESTWOOD DR
Practice Address - Street 2:SUITE 106
Practice Address - City:WOODBURY
Practice Address - State:NJ
Practice Address - Zip Code:08096-3144
Practice Address - Country:US
Practice Address - Phone:856-848-6262
Practice Address - Fax:856-848-6649
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00795500213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1747606Medicaid
NJ1747606Medicaid
NJDA610914Medicare ID - Type Unspecified