Most Relevant Information
Provider Data
| NPI Number: | 1003497470 |
| Provider Name: | ELENA L WICKSTROM MD |
| Entity Type: | Individual |
| Taxonomy Code: | 390200000X |
| Specialty: | Student in an Organized Health Care Education/Training Program |
| License Number: |
Most Important Dates
| Enumeration Date: | 04/17/2021 |
| Last Updated: | 03/28/2022 |
Provider Practice Location
185 S ORANGE AVE
NEWARK
NJ
071032757
Practice Location Phone/Fax
| Phone: | 7324454636 |
| Fax: |
Provider Mailing Location
185 S ORANGE AVE
NEWARK
NJ
071032757
Provider Mailing Phone/Fax
| Phone: | 7324454636 |
| Fax: |