Healthcare Provider Details

I. General information

NPI: 1689649758
Provider Name (Legal Business Name): BARBARA SUSAN WIEDER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

161 VISTA DR
CEDAR KNOLLS NJ
07927-2025
US

IV. Provider business mailing address

161 VISTA DR
CEDAR KNOLLS NJ
07927-2025
US

V. Phone/Fax

Practice location:
  • Phone: 973-984-1422
  • Fax:
Mailing address:
  • Phone: 973-984-1422
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LN0005X
TaxonomyCritical Care Neonatal Nurse Practitioner
License NumberF350163-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: