Matthias Heinz Wiederholz (NPI# 1336327279, PAC ID# 6305905639) is a physician enrolled in Centers for Medicare & Medicaid Services (CMS). The primary specialty is PHYSICAL MEDICINE AND REHABILITATION.
| Nation Provider ID (NPI) | 1336327279 |
| PAC ID by PECOS | 6305905639 |
| Professional Enrollment ID | I20081031000350 |
| Full Name | Matthias Heinz Wiederholz |
| Organization Legal Name | PERFORMANCE SPINE AND SPORTS MEDICINE OF BORDENTOWN LLC |
| Address |
9500 K Johnson Blvd Suite 1 Bordentown NJ 08505-2251 |
| Phone Number | 6095888600 |
| Gender | M |
| Medical School | UMDNJ-ROBERT WOOD JOHNSON MEDICAL SCHOOL |
| Graduation Year | 2003 |
| Primary Specialty | PHYSICAL MEDICINE AND REHABILITATION |
| Secondary Specialties | INTERVENTIONAL PAIN MANAGEMENT |
| Group Practice PAC ID | 1658502257 |
| Number of Group Practice Members | 2 |
| Accepts Medicare Assignment | Y |
| Claim Control Number (CCN) | Legal Business Name |
|---|---|
| 390258 | ST MARY MEDICAL CENTER |
| Address | Phone | Organization |
|---|---|---|
| 9500 K Johnson Blvd, Suite 1, Bordentown, NJ 08505-2251 | 6095888600 | PERFORMANCE SPINE AND SPORTS MEDICINE OF BORDENTOWN LLC |
| 4126 Southwest Fwy, Suite 1300, Houston, TX 77027-7310 | 6098170052 | PERFORMANCE PAIN AND SPORTS MEDICINE PLLC |
| 4056 Quakerbridge Rd, Suite 111, Lawrenceville, NJ 08648-4779 | 6095888600 | PERFORMANCE SPINE AND SPORTS MEDICINE |
| 828 Newtown Yardley Rd, Suite A, Newtown, PA 18940-1785 | 2155042223 | PERFORMANCE SPINE AND SPORTS MEDICINE OF NEWTOWN LLC |
| 903 Us Hwy 202, Suite 2a, Raritan, NJ 08869-1449 | 9087510980 | PERFORMANCE PAIN AND SPORTS MEDICINE OF RARITAN LLC |
| Organization Legal Name | PERFORMANCE SPINE AND SPORTS MEDICINE OF BORDENTOWN LLC |
| Physicians | 4 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Krishna D Konakondla | Sports Medicine | Performance Spine and Sports Medicine of Bordentown LLC | 9500 K Johnson Blvd, Suite 1, Bordentown, NJ 08505-2251 |
| Bryan Yam | Physical Therapy | Performance Spine and Sports Medicine of Bordentown LLC | 9500 K Johnson Blvd, Bordentown, NJ 08505-2251 |
| Tyressa L Savage | Chiropractic | Performance Spine and Sports Medicine of Bordentown LLC | 9500 K Johnson Blvd, Bordentown, NJ 08505-2251 |
| Street Address |
9500 K JOHNSON BLVD SUITE 1 |
| City | BORDENTOWN |
| State | NJ |
| Zip | 08505-2251 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| John Tooher | Physical Therapy | Jag-one Physical Therapy LLC | 9500 K Johnson Blvd, Bldg F, Bordentown, NJ 08505-2264 |
| Krishna D Konakondla | Sports Medicine | Performance Spine and Sports Medicine of Bordentown LLC | 9500 K Johnson Blvd, Suite 1, Bordentown, NJ 08505-2251 |
| Thomas G Gardner | Physical Therapy | Jag-one Physical Therapy LLC | 9500 K Johnson Blvd, Bldg F, Bordentown, NJ 08505-2264 |
| Bryan Yam | Physical Therapy | Performance Spine and Sports Medicine of Bordentown LLC | 9500 K Johnson Blvd, Bordentown, NJ 08505-2251 |
| Tyressa L Savage | Chiropractic | Performance Spine and Sports Medicine of Bordentown LLC | 9500 K Johnson Blvd, Bordentown, NJ 08505-2251 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Moishe Starkman | Family Practice | Bordentown Family Practice Pa | 163 Rte 130, Bordentown, NJ 08505 |
| Natalie Redziniak | Family Medicine | Capital Health Medical Group | 1 3rd St, Bordentown, NJ 08505-1321 |
| Danielle Carcia | Family Medicine | Capital Health Medical Group | 1 3rd St, Bordentown, NJ 08505-1321 |
| Janey B Hughes | Family Medicine | Capital Health Medical Group | 1 3rd St, Bordentown, NJ 08505-1321 |
| Rashmi Srikanth | Family Medicine | Capital Health Medical Group | 1 3rd St, Bordentown, NJ 08505-1321 |
| Omolabake Bankole | Family Medicine | Capital Health Medical Group | 1 3rd St, Bordentown, NJ 08505-1321 |
| Anne Marie Schulte | Clinical Social Worker | Capital Health Medical Group | 1 3rd St, Bordentown, NJ 08505-1321 |
| Renee B Hickman | Family Medicine | Capital Health Medical Group | 1 3rd St, Bordentown, NJ 08505-1321 |
| Maria Lugo | Family Medicine | Capital Health Medical Group | 1 3rd St, Bordentown, NJ 08505-1321 |
| Stephanie E Shapiro | Nurse Practitioner | Capital Health Medical Group | 1 3rd St, Bordentown, NJ 08505-1321 |
| Find all physicians in zip 08505 | |||
| City | BORDENTOWN |
| Zip Code | 08505 |
| Specialty | PHYSICAL MEDICINE AND REHABILITATION |
| City + Specialty | BORDENTOWN + PHYSICAL MEDICINE AND REHABILITATION |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS) |
| Jurisdiction | Medicare |
This dataset includes 1.12 million groups, individual physicians, and other clinicians currently enrolled in Medicare. Each physician is registered with NPI, PAC ID, full name, specialty, phone, organization, hospital, address, medical school, etc.