Provider Demographics
NPI:1205910890
Name:HUNTERDON ENDOCRINOLOGY AND DIABETES
Entity type:Organization
Organization Name:HUNTERDON ENDOCRINOLOGY AND DIABETES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WANDA
Authorized Official - Middle Name:D
Authorized Official - Last Name:RYAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:908-788-8111
Mailing Address - Street 1:121 STATE ROUTE 31
Mailing Address - Street 2:SUITE 300
Mailing Address - City:FLEMINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08822-5744
Mailing Address - Country:US
Mailing Address - Phone:908-788-8111
Mailing Address - Fax:908-788-8180
Practice Address - Street 1:121 STATE ROUTE 31
Practice Address - Street 2:SUITE 300
Practice Address - City:FLEMINGTON
Practice Address - State:NJ
Practice Address - Zip Code:08822-5744
Practice Address - Country:US
Practice Address - Phone:908-788-8111
Practice Address - Fax:908-788-8120
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-24
Last Update Date:2007-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA67670174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
059097Medicare PIN