Provider Demographics
NPI:1861545980
Name:KRIDER, WAYNE JOSEPH (PA-C)
Entity type:Individual
Prefix:MR
First Name:WAYNE
Middle Name:JOSEPH
Last Name:KRIDER
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 WELSHIRE DR
Mailing Address - Street 2:
Mailing Address - City:EGG HARBOR TOWNSHIP
Mailing Address - State:NJ
Mailing Address - Zip Code:08234-7113
Mailing Address - Country:US
Mailing Address - Phone:609-926-3183
Mailing Address - Fax:609-926-3183
Practice Address - Street 1:111 WEST WATER STREET
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08753
Practice Address - Country:US
Practice Address - Phone:732-244-4700
Practice Address - Fax:732-244-2804
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-19
Last Update Date:2009-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00053500363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJOTH000Medicare UPIN
NJ158185C2HMedicare PIN