Jan B. Wollack, MD, PHD

Primary specialty

Neurology with Special Qualifications in Child Neurology PhysicianTaxonomy code 2084N0402X

License

25MA070475 Issued in NJ

Practice address

19 Davis Ave
Neptune, NJ 07753-4488

Phone

(732) 776-4551

Fax

(732) 776-4392

NPI assigned

Oct 4, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NJ, NH2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 2

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine, Doctor of Philosophy

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: jan.wollack@direct.hackensackmeridian.org
• FHIR API: https://fhir4.healow.com/fhir/r4/IHJHBD

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Hackensack Meridian Health Medical Group - Complex Care PC

  • Internal Medicine Physician
  • Red Bank, NJ
  • NPI 1154379626
  Medicare reassignment NPD
• Hackensack Meridian Health Medical Group - Specialty Care PC

  • Surgical Critical Care Physician
  • Red Bank, NJ
  • NPI 1215989249
  Medicare reassignment NPD
• Dartmouth-Hitchcock Clinic

  • Internal Medicine Physician
  • Lebanon, NH
  • NPI 1548210198
  Medicare reassignment NPD
• Mary Hitchcock Memorial Hospital

  • General Acute Care Hospital
  • Lebanon, NH
  • NPI 1023092053
  Medicare reassignment NPD
• Hackensack Meridian Health Medical Group - Specialty Care PC

  • Durable Medical Equipment & Medical Supplies
  • North Bergen, NJ
  • NPI 1215734199
  NPD
• Mary Hitchcock Memorial Hospital

  • Psychiatric Hospital
  • Hampstead, NH
  • NPI 1699584219
  NPD
• Hackensack Meridian Health Medical Group - Specialty Care PC

  • Psychologist
  • Red Bank, NJ
  • NPI 1609593722
  NPD (past)

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

{
    "created_epoch": "1159920000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1574208000000",
    "number": "1447345608",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 MEDICAL CENTER DR",
            "address_2": "CHILD NEUROLOGY",
            "city": "LEBANON",
            "state": "NH",
            "postal_code": "037561000",
            "telephone_number": "603-653-9669",
            "fax_number": "603-653-9669"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19 DAVIS AVE",
            "city": "NEPTUNE",
            "state": "NJ",
            "postal_code": "077534488",
            "telephone_number": "732-776-4551",
            "fax_number": "732-776-4392"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WOLLACK",
        "first_name": "JAN",
        "middle_name": "B.",
        "credential": "MD, PHD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-04",
        "last_updated": "2019-11-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084N0402X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology with Special Qualifications in Child Neurology",
            "state": "NJ",
            "license": "25MA070475",
            "primary": true
        },
        {
            "code": "2084N0402X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology with Special Qualifications in Child Neurology",
            "state": "NH",
            "license": "17288",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8155003",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Laura Williamson, APN-BC
• Nancy Lynn Winouski, APN
• Kyle Wiseman, DO
• Lourdes Wisniewski, APN
• Thomas F Witomski, MD
• Adrianus Hilman Wong, LAC
• Tammy Lynn Wood, M.S. PA-C
• Natasha Wright, MA, LAC
• Jeffrey P Wu, M.D.
• Janice Marie Xenakis, PT, DPT

• Neurology with Special Qualifications in Child Neurology Physician in Neptune, NJ
• Providers in Neptune, NJ by specialty
• Neurology with Special Qualifications in Child Neurology Physician in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 20, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.