Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207T00000X | Neurosurgeon | 140417 | NY |
NPI | 1063407047 |
---|---|
Provider Name | Jeffrey H. Wisoff |
First Address | New York, NY 10016-4974 |
Second Address | New York, NY 10016-4974 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/09/2005 |
Last Update Date | 05/04/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01041198 | (05) | NY |
A63175 | (02) | NY |