NPIMap

Organization Active NPI

Jeffrey B. Wise, M.D., L.L.C.

  • Medical Specialty Clinic/Center
  • Wayne, NJ
National Provider Identifier
1124216718
Registry record updated Oct 9, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Specialty Clinic/CenterTaxonomy code 261QM2500X
License
25M08257300 Issued in NJ
Legal business name
JEFFREY B. WISE, M.D., L.L.C.
Practice address
1680 Route 23
Suite 100
Wayne, NJ 07470-7501
Phone
(973) 305-1400
Fax
(973) 694-5580
NPI assigned
Oct 9, 2007
Last updated
Oct 9, 2007By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 9, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Jeffrey Bruce Wise, M.D.NPI 1760698716
Title
Managing Member
Phone
(973) 305-1400

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Specialty Clinic/Center 261QM2500X 25M08257300 NJ Primary

Addresses

Primary practice location

1680 Route 23
Suite 100
Wayne, NJ 07470-7501

Mailing address

1680 Route 23
Suite 100
Wayne, NJ 07470-7501
Phone (973) 305-1400

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20071031000196 NJ Part B Supplier - Clinic/Group Practice 8325135825 Receives reassigned benefits from 1 practitioner
Practice locations: Wayne, NJ

National Provider Directory

National Provider Directory

Locations

1680 State Route 23
Ste 100
Wayne, NJ 07470
Phone (973) 305-1400

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1191888000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1191888000000",
    "number": "1124216718",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1680 ROUTE 23",
            "address_2": "SUITE 100",
            "city": "WAYNE",
            "state": "NJ",
            "postal_code": "074707501",
            "telephone_number": "973-305-1400",
            "fax_number": "973-694-5580"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1680 ROUTE 23",
            "address_2": "SUITE 100",
            "city": "WAYNE",
            "state": "NJ",
            "postal_code": "074707501",
            "telephone_number": "973-305-1400",
            "fax_number": "973-694-5580"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JEFFREY B. WISE, M.D., L.L.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-10-09",
        "last_updated": "2007-10-09",
        "status": "A",
        "authorized_official_last_name": "WISE",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_middle_name": "BRUCE",
        "authorized_official_title_or_position": "MANAGING MEMBER",
        "authorized_official_telephone_number": "973-305-1400",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QM2500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Medical Specialty",
            "state": "NJ",
            "license": "25M08257300",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wayne, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.