Provider Demographics
NPI:1427028596
Name:KODISH-WACHS, JODI E (MD)
Entity Type:Individual
Prefix:DR
First Name:JODI
Middle Name:E
Last Name:KODISH-WACHS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JODI
Other - Middle Name:E
Other - Last Name:KODISH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 635
Mailing Address - Street 2:
Mailing Address - City:BELLMAWR
Mailing Address - State:NJ
Mailing Address - Zip Code:08099-0635
Mailing Address - Country:US
Mailing Address - Phone:856-770-5772
Mailing Address - Fax:856-566-2797
Practice Address - Street 1:42 LAUREL RD E
Practice Address - Street 2:UDP #1700
Practice Address - City:STRATFORD
Practice Address - State:NJ
Practice Address - Zip Code:08084-1354
Practice Address - Country:US
Practice Address - Phone:856-566-7010
Practice Address - Fax:856-566-6956
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA07556200208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0030813Medicaid
NJ081373C60Medicare ID - Type Unspecified
NJI11637Medicare UPIN