Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QS0010X | Family Doctor - Sports Medicine | OS020477 | PA |
NPI | 1275989667 |
---|---|
Provider Name | Jeffrey Wisinski |
First Address | Hershey, PA 17033-0858 |
Second Address | State College, PA 16803-6706 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/05/2016 |
Last Update Date | 01/07/2020 |