Provider Demographics
NPI:1518906064
Name:WELCH, WINIFRED A (PT)
Entity Type:Individual
Prefix:
First Name:WINIFRED
Middle Name:A
Last Name:WELCH
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1430 HOOPER AVE
Mailing Address - Street 2:STE 201
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08753-2895
Mailing Address - Country:US
Mailing Address - Phone:732-914-0000
Mailing Address - Fax:732-914-0007
Practice Address - Street 1:1430 HOOPER AVE
Practice Address - Street 2:STE 201
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08753-2895
Practice Address - Country:US
Practice Address - Phone:732-914-0000
Practice Address - Fax:732-914-0007
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2007-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00430800174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJP61003Medicare UPIN
NJ049454Medicare PIN