Provider Demographics
NPI:1518028307
Name:SHERTZ-DIPIETRO, WENDY T (MD)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:T
Last Name:SHERTZ-DIPIETRO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:WENDY
Other - Middle Name:
Other - Last Name:DIPIETRO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 417
Mailing Address - Street 2:279 THIRD AVENUE SUITE 104
Mailing Address - City:LONG BRANCH
Mailing Address - State:NJ
Mailing Address - Zip Code:07740
Mailing Address - Country:US
Mailing Address - Phone:732-229-8711
Mailing Address - Fax:732-229-0245
Practice Address - Street 1:300 SECOND AVENUE
Practice Address - Street 2:MONMOUTH MEDICAL CENTER DEPT OF PATHOLOGY
Practice Address - City:LONG BRANCH
Practice Address - State:NJ
Practice Address - Zip Code:07740
Practice Address - Country:US
Practice Address - Phone:732-229-8711
Practice Address - Fax:732-229-0245
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2019-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA04831900207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2309602Medicaid
C58512Medicare UPIN
NJSH565562Medicare ID - Type Unspecified