Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2084N0400X | Neurologist | 172438 | NY |
NPI | 1033103759 |
---|---|
Provider Name | Thomas Wisniewski |
First Address | New York, NY 10016-4901 |
Second Address | New York, NY 10016-4901 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/09/2005 |
Last Update Date | 25/09/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E17667 | (02) | NY |