Provider Demographics
NPI:1659331114
Name:WAHBA, JANETTE M (MD)
Entity Type:Individual
Prefix:
First Name:JANETTE
Middle Name:M
Last Name:WAHBA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:LYNDHURST
Mailing Address - State:NJ
Mailing Address - Zip Code:07071-2739
Mailing Address - Country:US
Mailing Address - Phone:201-935-5512
Mailing Address - Fax:201-935-1914
Practice Address - Street 1:525 RIDGE RD
Practice Address - Street 2:
Practice Address - City:LYNDHURST
Practice Address - State:NJ
Practice Address - Zip Code:07071-2739
Practice Address - Country:US
Practice Address - Phone:201-935-5512
Practice Address - Fax:201-935-1914
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-27
Last Update Date:2012-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA030934002080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1879308Medicaid