Provider Demographics
NPI:1336174416
Name:CERVI, WENDY LEE (DO)
Entity type:Individual
Prefix:DR
First Name:WENDY
Middle Name:LEE
Last Name:CERVI
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 SANDY RIDGE MOUNT AIRY RD
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08559-2009
Mailing Address - Country:US
Mailing Address - Phone:609-397-3924
Mailing Address - Fax:609-278-4201
Practice Address - Street 1:321 N WARREN ST
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:NJ
Practice Address - Zip Code:08618-4741
Practice Address - Country:US
Practice Address - Phone:609-278-5917
Practice Address - Fax:609-278-4201
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2012-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB07448400207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8893705Medicaid
084125C3HMedicare ID - Type Unspecified
NJ8893705Medicaid