Provider Demographics
NPI:1649268616
Name:WOHLSTADTER, SANFORD (MD,FACOG)
Entity type:Individual
Prefix:DR
First Name:SANFORD
Middle Name:
Last Name:WOHLSTADTER
Suffix:
Gender:M
Credentials:MD,FACOG
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:704 N BEERS ST
Mailing Address - Street 2:
Mailing Address - City:HOLMDEL
Mailing Address - State:NJ
Mailing Address - Zip Code:07733-1519
Mailing Address - Country:US
Mailing Address - Phone:732-739-2500
Mailing Address - Fax:732-888-2778
Practice Address - Street 1:704 N BEERS ST
Practice Address - Street 2:
Practice Address - City:HOLMDEL
Practice Address - State:NJ
Practice Address - Zip Code:07733-1519
Practice Address - Country:US
Practice Address - Phone:732-739-2500
Practice Address - Fax:732-888-2778
Is Sole Proprietor?:No
Enumeration Date:2005-10-12
Last Update Date:2007-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA044568207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0098027000OtherAMERIHEALTH
NJ0520101Medicaid
NJ0K4836OtherHEALTHNET
NJMP094OtherOXFORD
NJ406320BKLMedicare PIN
NJD98971Medicare UPIN