Provider Demographics
NPI:1154394963
Name:WHEATLEY, HAROLD MATTHEW (MD)
Entity type:Individual
Prefix:DR
First Name:HAROLD
Middle Name:MATTHEW
Last Name:WHEATLEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1000 GALLOPING HILL RD STE 305
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:NJ
Mailing Address - Zip Code:07083-7991
Mailing Address - Country:US
Mailing Address - Phone:908-458-8333
Mailing Address - Fax:908-458-8339
Practice Address - Street 1:10 PLUM ST
Practice Address - Street 2:SUITE 600
Practice Address - City:NEW BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08901-2065
Practice Address - Country:US
Practice Address - Phone:732-220-1600
Practice Address - Fax:732-220-1603
Is Sole Proprietor?:No
Enumeration Date:2006-02-10
Last Update Date:2017-08-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA07110100207WX0107X
NJ71101207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
G71254Medicare UPIN