Wanda Janina Mikulski, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

MA035627 Issued in MD

Practice address

1310 Broad St
Bloomfield, NJ 07003

Phone

(973) 338-5660

Fax

(973) 338-0522

NPI assigned

Aug 29, 2006

Last updated

Apr 17, 2009By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NJ

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 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1156809600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1239926400000",
    "number": "1962510727",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1310 BROAD ST",
            "city": "BLOOMFIELD",
            "state": "NJ",
            "postal_code": "07003",
            "telephone_number": "973-338-5660",
            "fax_number": "973-338-0522"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1310 BROAD ST",
            "city": "BLOOMFIELD",
            "state": "NJ",
            "postal_code": "07003",
            "telephone_number": "973-338-5660",
            "fax_number": "973-338-0522"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MIKULSKI",
        "first_name": "WANDA",
        "middle_name": "JANINA",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-08-29",
        "last_updated": "2009-04-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MD",
            "license": "MA035627",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1097806",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Dimitris Myles Meredith, LPC
• Metafit Complete, LLC
• Michael H Sutton
• Kimberly Michel, DNP, PMHNP-BC
• Melissa Jane Middleman, LCSW
• Paul M Miller
• Scott Steven Miller, PH.D.
• Barbara Jean Minemier, HEALTH COACH
• Rekha Miryala, M.D
• Niti Mistry, OD

• Family Medicine Physician in Bloomfield, NJ
• Providers in Bloomfield, NJ by specialty
• Family Medicine Physician in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 17, 2009; 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.