Provider Demographics
NPI:1497980734
Name:ANN WRY,MD., LLC
Entity Type:Organization
Organization Name:ANN WRY,MD., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANN
Authorized Official - Middle Name:M
Authorized Official - Last Name:WRY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-368-0201
Mailing Address - Street 1:114 ESSEX ST
Mailing Address - Street 2:
Mailing Address - City:ROCHELLE PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07662-4335
Mailing Address - Country:US
Mailing Address - Phone:201-368-0201
Mailing Address - Fax:201-368-0346
Practice Address - Street 1:114 ESSEX ST
Practice Address - Street 2:
Practice Address - City:ROCHELLE PARK
Practice Address - State:NJ
Practice Address - Zip Code:07662-4335
Practice Address - Country:US
Practice Address - Phone:201-368-0201
Practice Address - Fax:201-368-0346
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-15
Last Update Date:2009-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06650300261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ159767OtherMEDICARE PTAN