Individual
JAN B. WOLLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD, PHD
Contact information
Practice address
19 DAVIS AVE, NEPTUNE, NJ 07753-4488
(732) 776-4551
(732) 776-4392
Mailing address
1 MEDICAL CENTER DR, CHILD NEUROLOGY, LEBANON, NH 03756-1000
(603) 653-9669
(603) 653-9669
Taxonomy
Speciality
Code
Description
License number
State
2084N0402X
Neurology with Special Qualifications in Child Neurology Physician
17288
NH
2084N0402X
Neurology with Special Qualifications in Child Neurology Physician
Primary
25MA070475
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8155003
—
NJ
Enumeration date
10/04/2006
Last updated
11/20/2019
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