DR. PHILLIP ASHLEY WACKYM (NPI# 1720030315) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1720030315 |
| Entity Type | Individual |
| Full Name | DR. PHILLIP ASHLEY WACKYM |
| Other Name | DR. P. ASHLEY WACKYM |
| Credential | MD |
| Practice Address |
10 Plum St Fl 5 Department of Otolaryngology - Head and Neck Surgery New Brunswick NJ 08901-2066 |
| Mailing Address |
135 Somerset St #511 New Brunswick NJ 08901-2072 |
| Practice Telephone | 7322356305 |
| Mailing Telephone | 7322356305 |
| Enumeration Date | 2006-05-16 |
| Last Update Date | 2016-09-12 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207YX0901X |
Otolaryngology Specialization: Otology & Neurotology |
25MA09934900 | NJ | Allopathic & Osteopathic Physicians |
| Street Address |
10 PLUM ST FL 5 DEPARTMENT OF OTOLARYNGOLOGY - HEAD AND NECK SURGERY |
| City | NEW BRUNSWICK |
| State | NJ |
| Zip Code | 08901-2066 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1346729530 | Sydney Lee Johnson | Nurse Practitioner | 10 Plum St Fl 5, New Brunswick, NJ 08901-2066 | 2018-08-09 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1083242622 | Daniel Kareem Haddad | Student in an Organized Health Care Education/Training Program | 1 Robert Wood Johnson Place, Meb 422a, New Brunswick, NJ 08901 | 2020-03-30 |
| 1922636588 | Neil Anjan Basumallik | Student in an Organized Health Care Education/Training Program | Rutgers Rwjms, Department of Medicine, 125 Paterson Street. Cab 7300, New Brunswick, NJ 08901 | 2020-03-30 |
| 1922636406 | Naveena Lall | Student in an Organized Health Care Education/Training Program | Rutgers Robert Wood Johnson Internal Medicine Residency, 125 Paterson Street, New Brunswick, NJ 08901 | 2020-03-30 |
| 1801444047 | Swati Vijay Dhobale | Student in an Organized Health Care Education/Training Program | Saint Peter's University Hospital, 254 Easton Avenue, 4th Floor, Cares Room 4014, New Brunswick, NJ 08901 | 2019-08-30 |
| 1962974329 | Lauren Burgstresser | Nurse Practitioner | 181 Somerset Street, 3rd Floor, New Brunswick, NJ 08901 | 2018-12-26 |
| 1851874291 | Damon House Inc. | Substance Abuse Rehabilitation Facility | 105 Joyce Kilmer Ave, New Brunswick, NJ 08901 | 2018-09-12 |
| 1245718204 | Leah Dinardo | Psychologist | 61 Nichol Ave, New Brunswick, NJ 08901 | 2018-08-01 |
| 1730667130 | Keshav Bhandari | Student in an Organized Health Care Education/Training Program | Saint Peters University Hospital, 254 Easton Avenue, 4th Floor Cares, Rm 4014, New Brunswick, NJ 08901 | 2018-07-30 |
| 1942787486 | Mehak Bassi | Student in an Organized Health Care Education/Training Program | 4th Floor Cares, Rm 4014 240 Easton Avenue, New Brunswick, NJ 08901 | 2018-07-27 |
| 1063908754 | Oluwatoba Opeyemi Moninuola | Student in an Organized Health Care Education/Training Program | 4th Floor Cares, Rm 4014, 240 Easton Avenue, New Brunswick, NJ 08901 | 2018-07-05 |
| Find all providers in zip 08901 | ||||
| Taxonomy Code | 207YX0901X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Otolaryngology |
| Specialization | Otology & Neurotology |
| An otolaryngologist who treats diseases of the ear and temporal bone, including disorders of hearing and balance. The additional training in otology and neurotology emphasizes the study of embryology, anatomy, physiology, epidemiology, pathophysiology, pathology, genetics, immunology, microbiology and the etiology of diseases of the ear and temporal bone. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definiton added, source added] Additional Resources: American Board of Otolaryngology, 2007. http://www.aboto.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Otolaryngology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1114390739 | Pei Lin, Md | Otolaryngology | 3624 Jfk Blvd, Jersey City, NJ 07307 | 2015-11-04 |
| 1205091527 | Yu-lan Mary Ying | Otolaryngology | 90 Bergen Street Suite 8100, Newark, NJ 07103-2425 | 2008-07-25 |
| 1770943896 | Acm Ear, Nose, Throat | Otolaryngology | 3624 Jfk Blvd, Jersey City, NJ 07307 | 2016-03-02 |
| 1134367501 | Anthony F. Jahn,m.d.,pa | Otolaryngology | 556 Eagle Rock Ave, Suite 201, Roseland, NJ 07068-1503 | 2009-01-23 |
| 1083718456 | Darsit Kanaiyalal Shah | Otolaryngology | 1131 Broad Street, Ste 103, Shrewsbury, NJ 07702 | 2006-09-07 |
| 1831163278 | Sapna Sureshkumar Brahmbhatt | Otolaryngology | 55 Schanck Rd, Suite A-4, Freehold, NJ 07728-2964 | 2006-02-14 |
| City | NEW BRUNSWICK |
| Zip Code | 08901 |
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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.