Provider Demographics
NPI:1336211788
Name:DWYER, WENDY K
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:K
Last Name:DWYER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:903 US HIGHWAY 202
Mailing Address - Street 2:
Mailing Address - City:RARITAN
Mailing Address - State:NJ
Mailing Address - Zip Code:08869-1419
Mailing Address - Country:US
Mailing Address - Phone:908-725-1144
Mailing Address - Fax:
Practice Address - Street 1:903 US HIGHWAY 202
Practice Address - Street 2:
Practice Address - City:RARITAN
Practice Address - State:NJ
Practice Address - Zip Code:08869-1419
Practice Address - Country:US
Practice Address - Phone:908-725-1144
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJQA07499225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ222386098OtherHEALTHNET NUMBER
NJ3530214OtherAETNA NUMBER
NJ222386098OtherOXFORD NUMBER
NJ114251300OtherDEPT OF LABOR
NJ222386098OtherOXFORD NUMBER