Healthcare Provider Details

I. General information

NPI: 1437847837
Provider Name (Legal Business Name): WISEMD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2023
Last Update Date: 11/16/2024
Certification Date: 11/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 W 4TH ST
MADERA CA
93637-4474
US

IV. Provider business mailing address

1111 W 4TH ST
MADERA CA
93637-4474
US

V. Phone/Fax

Practice location:
  • Phone: 516-467-9393
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207QS1201X
TaxonomySleep Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. TABISH AFTAB NAZ
Title or Position: CEO/PRESIDENT
Credential: MD
Phone: 516-467-9393