Provider Demographics
NPI:1245351287
Name:WOODLYNNE MEDICAL ASSOCIATES,PC
Entity type:Organization
Organization Name:WOODLYNNE MEDICAL ASSOCIATES,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:TRAM
Authorized Official - Middle Name:N
Authorized Official - Last Name:LE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-962-8840
Mailing Address - Street 1:2301 WOODLYNNE AVE
Mailing Address - Street 2:
Mailing Address - City:OAKLYN
Mailing Address - State:NJ
Mailing Address - Zip Code:08107-2242
Mailing Address - Country:US
Mailing Address - Phone:856-962-8840
Mailing Address - Fax:
Practice Address - Street 1:2301 WOODLYNNE AVE
Practice Address - Street 2:
Practice Address - City:OAKLYN
Practice Address - State:NJ
Practice Address - Zip Code:08107-2242
Practice Address - Country:US
Practice Address - Phone:856-962-8840
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2011-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA065103207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ9070907Medicaid
NJ020819Medicare ID - Type Unspecified
NJ9070907Medicaid