1982788816 NPI number — STERLING HERBERT WOOD DO

Table of content: STERLING HERBERT WOOD DO (NPI 1982788816)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982788816 NPI number — STERLING HERBERT WOOD DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WOOD
Provider First Name:
STERLING
Provider Middle Name:
HERBERT
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DO
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1982788816
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 188
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LITTLE SILVER
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07739
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
732-264-1127
Provider Business Mailing Address Fax Number:
732-264-0670

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
655 SHREWSBURY AVENUE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SHREWSBURY
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07702
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
732-450-6000
Provider Business Practice Location Address Fax Number:
732-450-1798
Provider Enumeration Date:
10/25/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207L00000X , with the licence number:  25MB07531500 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)