Provider Demographics
NPI:1689088254
Name:WITTENBERG, FRED
Entity Type:Individual
Prefix:
First Name:FRED
Middle Name:
Last Name:WITTENBERG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:HADDONFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:08033-3341
Mailing Address - Country:US
Mailing Address - Phone:856-354-0048
Mailing Address - Fax:
Practice Address - Street 1:30 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:HADDONFIELD
Practice Address - State:NJ
Practice Address - Zip Code:08033-3341
Practice Address - Country:US
Practice Address - Phone:856-354-0048
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-11
Last Update Date:2014-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246Y00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Health InformationGroup - Single Specialty