JAN B. WOLLACK (NPI# 1447345608) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1447345608 |
| Entity Type | Individual |
| Full Name | JAN B. WOLLACK |
| Credential | MD, PHD |
| Practice Address |
19 Davis Ave Neptune NJ 07753-4488 |
| Mailing Address |
1 Medical Center Dr Child Neurology Lebanon NH 03756-1000 |
| Practice Telephone | 7327764551 |
| Practice Fax Number | 7327764392 |
| Mailing Telephone | 6036539669 |
| Mailing Fax Number | 6036539669 |
| Enumeration Date | 2006-10-04 |
| Last Update Date | 2019-11-20 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 2084N0402X |
Psychiatry & Neurology Specialization: Neurology with Special Qualifications in Child Neurology |
17288 | NH | Allopathic & Osteopathic Physicians |
| Y | 2084N0402X |
Psychiatry & Neurology Specialization: Neurology with Special Qualifications in Child Neurology |
25MA070475 | NJ | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NJ | 8155003 | 05 |
| Street Address |
19 DAVIS AVE |
| City | NEPTUNE |
| State | NJ |
| Zip Code | 07753-4488 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1801879598 | Carmelita Mabanta | Pediatrics | 19 Davis Ave, Neptune, NJ 07753-4488 | 2005-11-28 |
| 1942826458 | Kristina Marie Dauernheim | Surgery | 19 Davis Ave, 4th Floor Hope Tower, Neptune, NJ 07753 | 2020-06-20 |
| 1235773490 | Ruchi Shah | Physician Assistant | 19 Davis Ave, Neptune, NJ 07753-4488 | 2019-10-31 |
| 1588206080 | Haley Frati | Physician Assistant | 19 Davis Ave, Neptune, NJ 07753-4488 | 2019-10-16 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255938361 | Maryjoy Marzan | Nurse Practitioner | Hope Tower - Jersey Shore University Medical Center, 19 Davis St 6th Floor, Neptune, NJ 07753 | 2020-10-02 |
| 1174138952 | Darlene Lupo | Nurse Practitioner | 72 Morris Ave, Neptune, NJ 07753 | 2020-09-09 |
| 1124645148 | Charlotte Emily Parker | Audiologist | 3700 Nj-33, Suite 101, Neptune City, NJ 07753 | 2020-06-26 |
| 1023667896 | Joseph Renninger | Psychologist | 2100 Route 33 Suite 9/10, Neptune, NJ 07753 | 2019-09-05 |
| 1952950800 | Matthew Aaron Brigle | Psychologist | 2100 Nj-33, Suite 9-10, Neptune City, NJ 07753 | 2019-09-04 |
| 1285292110 | Joseph F Mcnamara | Nurse Practitioner | 1945 Nj State Highway 33, Neptune, NJ 07753 | 2019-06-05 |
| 1679046601 | Richard Valderas Penalosa Jr. | Nurse Practitioner | 409 Locust St, Neptune, NJ 07753 | 2019-01-02 |
| 1528539822 | Neptune Rx LLC | Pharmacy | West Lake Pharmacy, 1828 West Lake Avenue, Neptune, NJ 07753 | 2018-12-12 |
| 1053880286 | Hmh Hospitals Corporation | Clinic/Center | 1200 Jumping Brook Rd., Bldg 5, Ste 201, Neptune, NJ 07753 | 2018-11-16 |
| 1972084424 | Melissa Hillebrecht | Psychologist | 2100 Nj-33 Suite 9-10, Neptune, NJ 07753 | 2018-08-23 |
| Find all providers in zip 07753 | ||||
| Taxonomy Code | 2084N0402X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Psychiatry & Neurology |
| Specialization | Neurology with Special Qualifications in Child Neurology |
| A Child Neurologist specializes in neurology with special skills in diagnosis and treatment of neurologic disorders of the neonatal period, infancy, early childhood, and adolescence. |
| Notes: Source: The American Board of Psychiatry and Neurology, Inc. www.abpn.com [1/1/2007: new definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598751083 | Dorothy Mary Pietrucha | Psychiatry & Neurology | 81 Davis Ave, Suite 4, Neptune, NJ 07753-4483 | 2005-09-21 |
| 1467452722 | Roopal M. Karia | Psychiatry & Neurology | 1944 State Hwy 33, Ste 102, Neptune, NJ 07754 | 2005-07-28 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1316467640 | Kidsneuro, LLC | Psychiatry & Neurology | 205 Browertown Rd Ste 1, Woodland Park, NJ 07424-2610 | 2017-06-27 |
| 1255871547 | Vinayak Dattatraya Bodas | Psychiatry & Neurology | 268 M.l. King Blvd., Newark, NJ 07102 | 2017-03-06 |
| 1013306885 | Namita Garg | Psychiatry & Neurology | 7 Bell St, Apartment # 401, Montclair, NJ 07042-2232 | 2015-01-16 |
| 1477895167 | Bridget Anne Leone | Psychiatry & Neurology | 200 S Orange Ave Ste 165, Livingston, NJ 07039 | 2013-03-20 |
| 1700047594 | Vikram Bhise | Psychiatry & Neurology | 89 French St Fl 2, Children's Health Institute of New Jersey, New Brunswick, NJ 08901-1935 | 2008-06-24 |
| 1952526816 | German Laufer | Psychiatry & Neurology | 22 Knutsen Dr, West Orange, NJ 07052-2162 | 2007-04-16 |
| 1215096524 | Neuroscience Assoc Md Pa | Psychiatry & Neurology | 31 Mountain Blvd Bldg A, Warren, NJ 07059-5645 | 2006-12-06 |
| 1700961307 | Beverly Fischer | Psychiatry & Neurology | 4 Chiplou Ln, Scotch Plains, NJ 07076-2204 | 2006-10-25 |
| 1851487193 | Leonid Lev Topper | Psychiatry & Neurology | 34 Mountain Blvd Ste B, Warren, NJ 07059-2640 | 2006-10-05 |
| 1578663738 | Gabor Barabas | Psychiatry & Neurology | 24 Muncy Dr, West Long Branch, NJ 07764-1147 | 2006-09-25 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.