Provider Demographics
NPI:1437146792
Name:WANGENHEIM, PAUL (MD)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:
Last Name:WANGENHEIM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:741 NORTHFIELD AVE
Mailing Address - Street 2:STE 205
Mailing Address - City:WEST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07052-1174
Mailing Address - Country:US
Mailing Address - Phone:973-467-1544
Mailing Address - Fax:973-467-9586
Practice Address - Street 1:741 NORTHFIELD AVE
Practice Address - Street 2:STE 205
Practice Address - City:WEST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07052-1174
Practice Address - Country:US
Practice Address - Phone:973-467-1544
Practice Address - Fax:973-467-9586
Is Sole Proprietor?:No
Enumeration Date:2005-10-03
Last Update Date:2013-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ43085207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
1K9394OtherHEALTHNET
5710574OtherGHI
NJ1918206Medicaid
4116261OtherAETNA
01000350800OtherAMERICHOICE
1001644002OtherCIGNA
ES229OtherOXFORD
81557OtherAMERIGROUP
19E881OtherWELLCHOICE
0300997000OtherAMERIHEALTH
0300997000OtherAMERIHEALTH
1K9394OtherHEALTHNET