Healthcare Provider Details

I. General information

NPI: 1689750069
Provider Name (Legal Business Name): PAUL NEIL WIENER P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/28/2006
Last Update Date: 01/30/2020
Certification Date: 01/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

170 PROSPECT AVE STE 2
HACKENSACK NJ
07601-1834
US

IV. Provider business mailing address

170 PROSPECT AVE APT 5L
HACKENSACK NJ
07601-1858
US

V. Phone/Fax

Practice location:
  • Phone: 201-880-8303
  • Fax: 201-880-4893
Mailing address:
  • Phone: 201-956-4188
  • Fax: 201-956-4893

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number018834-1
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberQA4003741
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: