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NPI Code Detail

MEDICARE: KEANU WIENS

MEDICARE: KEANU WIENS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1175T00000XPeer SpecialistNY

General Provider Information

NPI Number : 1265362537
Entity Type Code : Individual
Provider Name (Legal Business Name) : KEANU WIENS
Provider Business Mailing Address
First Line : 1623 KINGS HWY
Second Line :
City : BROOKLYN
State : NY
Zip : 11229-1209
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1623 KINGS HWY
Second Line :
City : BROOKLYN
State : NY
Zip : 11229-1209
Country : US
Telephone Number : 929-636-5917
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/20/2026
Last Update Date : 05/20/2026

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Directions to “ KEANU WIENS ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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