Provider Demographics
NPI:1962525782
Name:WOLF, RENEE CHRISTINE (PHYSICIAN ASSISTANT)
Entity type:Individual
Prefix:
First Name:RENEE
Middle Name:CHRISTINE
Last Name:WOLF
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:160 AVENUE AT THE CMN
Mailing Address - Street 2:SUITE 1
Mailing Address - City:SHREWSBURY
Mailing Address - State:NJ
Mailing Address - Zip Code:07702-4802
Mailing Address - Country:US
Mailing Address - Phone:732-380-0200
Mailing Address - Fax:732-380-0262
Practice Address - Street 1:160 AVENUE AT THE CMN
Practice Address - Street 2:SUITE 1
Practice Address - City:SHREWSBURY
Practice Address - State:NJ
Practice Address - Zip Code:07702-4802
Practice Address - Country:US
Practice Address - Phone:732-380-0200
Practice Address - Fax:732-380-0262
Is Sole Proprietor?:No
Enumeration Date:2007-04-08
Last Update Date:2011-06-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ00685363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
G75219Medicare UPIN