Individual
WADE METRO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
350 ENGLE ST, ENGLEWOOD, NJ 07631-1808
(201) 894-3322
(201) 894-0585
Mailing address
375 ENGLE ST, SECOND FLOOR, ENGLEWOOD, NJ 07631-1823
(201) 871-0673
(201) 655-6159
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
25MA05757600
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02817256
—
NY
01
—
050070854
RAILROAD MEDICARE
NJ
05
—
9095608
—
NJ
Enumeration date
05/15/2006
Last updated
08/18/2011
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