Provider Demographics
NPI:1831116607
Name:NACH, WENDY GAYLE (DPM)
Entity Type:Individual
Prefix:DR
First Name:WENDY
Middle Name:GAYLE
Last Name:NACH
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15-01 BROADWAY
Mailing Address - Street 2:30C
Mailing Address - City:FAIR LAWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07410-6003
Mailing Address - Country:US
Mailing Address - Phone:201-794-6656
Mailing Address - Fax:201-794-7642
Practice Address - Street 1:15-01 BROADWAY
Practice Address - Street 2:30C
Practice Address - City:FAIR LAWN
Practice Address - State:NJ
Practice Address - Zip Code:07410-6003
Practice Address - Country:US
Practice Address - Phone:201-794-6656
Practice Address - Fax:201-794-7642
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-16
Last Update Date:2008-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00182700213ES0131X
NJMD001827213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1093105OtherHORIZONNJHEALTH
NJ4619404Medicaid
NJF13733OtherHEALTH NET
NJ0114531000OtherAMERIHEALTH
NJ0114531000OtherAMERIHEALTH
NJT45700Medicare UPIN