Provider Demographics
NPI:1629145115
Name:WITTENBORN, JOHN R (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:R
Last Name:WITTENBORN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 363
Mailing Address - Street 2:
Mailing Address - City:BERNARDSVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07924-0363
Mailing Address - Country:US
Mailing Address - Phone:908-696-8940
Mailing Address - Fax:609-261-7199
Practice Address - Street 1:215 UNION AVE
Practice Address - Street 2:SUITE B
Practice Address - City:BRIDGEWATER
Practice Address - State:NJ
Practice Address - Zip Code:08807-3063
Practice Address - Country:US
Practice Address - Phone:609-261-5755
Practice Address - Fax:609-261-7199
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJMA070083207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
669902OtherHIGHMARK
0231523000OtherAMERIHEALTH KEYSTONE PC
1161130OtherMECY HORIZON NJ HEALTH
NJ2336458OtherAETNA
P2052026OtherOXFORD
P2052026OtherOXFORD
D83930Medicare UPIN