Provider Demographics
NPI:1154364768
Name:WOLITZKY, JAN I (PAC)
Entity type:Individual
Prefix:
First Name:JAN
Middle Name:I
Last Name:WOLITZKY
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:766 US HIGHWAY 202 206
Mailing Address - Street 2:SUITE 1
Mailing Address - City:BRIDGEWATER
Mailing Address - State:NJ
Mailing Address - Zip Code:08807-1773
Mailing Address - Country:US
Mailing Address - Phone:908-722-0808
Mailing Address - Fax:908-722-7645
Practice Address - Street 1:766 US HIGHWAY 202 206
Practice Address - Street 2:SUITE 1
Practice Address - City:BRIDGEWATER
Practice Address - State:NJ
Practice Address - Zip Code:08807-1773
Practice Address - Country:US
Practice Address - Phone:908-722-0808
Practice Address - Fax:908-722-7645
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2017-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00107500363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ073520Medicare PIN
NJP94701Medicare UPIN