Provider Demographics
NPI:1124066709
Name:WLB MEDICAL ASSOCIATES, P.C.
Entity type:Organization
Organization Name:WLB MEDICAL ASSOCIATES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CARL
Authorized Official - Middle Name:
Authorized Official - Last Name:MARCHETTI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-775-8789
Mailing Address - Street 1:241 MONMOUTH RD
Mailing Address - Street 2:
Mailing Address - City:WEST LONG BRANCH
Mailing Address - State:NJ
Mailing Address - Zip Code:07764-1177
Mailing Address - Country:US
Mailing Address - Phone:732-263-7910
Mailing Address - Fax:732-263-7912
Practice Address - Street 1:241 MONMOUTH RD
Practice Address - Street 2:
Practice Address - City:WEST LONG BRANCH
Practice Address - State:NJ
Practice Address - Zip Code:07764-1177
Practice Address - Country:US
Practice Address - Phone:732-263-7910
Practice Address - Fax:732-263-7912
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-03
Last Update Date:2009-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA60758207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJF98287Medicare UPIN
NJ504553RYXMedicare PIN