Provider Demographics
NPI:1144322983
Name:WOSNITZER, MOREY (MD)
Entity type:Individual
Prefix:DR
First Name:MOREY
Middle Name:
Last Name:WOSNITZER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 MORRIS AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07081-1156
Mailing Address - Country:US
Mailing Address - Phone:973-379-6949
Mailing Address - Fax:973-379-2227
Practice Address - Street 1:420 MORRIS AVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07081-1156
Practice Address - Country:US
Practice Address - Phone:973-379-6949
Practice Address - Fax:973-379-2227
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA01954800174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJC55205Medicare UPIN