Provider Demographics
NPI:1053355503
Name:STINSON, WENDY K (DPM)
Entity type:Individual
Prefix:
First Name:WENDY
Middle Name:K
Last Name:STINSON
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 S PARK PL # 295
Mailing Address - Street 2:
Mailing Address - City:MORRISTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07960-3924
Mailing Address - Country:US
Mailing Address - Phone:973-382-6999
Mailing Address - Fax:
Practice Address - Street 1:3799 ROUTE 46 STE 103
Practice Address - Street 2:
Practice Address - City:PARSIPPANY
Practice Address - State:NJ
Practice Address - Zip Code:07054-1158
Practice Address - Country:US
Practice Address - Phone:973-382-6999
Practice Address - Fax:973-381-2355
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-15
Last Update Date:2024-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00273900213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJD08334300OtherCDS LICENSE
NJD08334300OtherCDS LICENSE
NJU38028Medicare UPIN