Provider Demographics
NPI:1497802938
Name:WILDERMAN, MICHAEL JEFFREY (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:JEFFREY
Last Name:WILDERMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:211 ESSEX ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601-3231
Mailing Address - Country:US
Mailing Address - Phone:201-487-8882
Mailing Address - Fax:201-487-0943
Practice Address - Street 1:211 ESSEX ST
Practice Address - Street 2:SUITE 102
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-3231
Practice Address - Country:US
Practice Address - Phone:201-487-8882
Practice Address - Fax:201-487-0943
Is Sole Proprietor?:No
Enumeration Date:2007-01-05
Last Update Date:2014-05-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA085696002086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery