Healthcare Provider Details

I. General information

NPI: 1720145709
Provider Name (Legal Business Name): WIENER & PAGANO, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/02/2007
Last Update Date: 08/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

299 MARKET ST
SADDLE BROOK NJ
07663-5316
US

IV. Provider business mailing address

299 MARKET ST
SADDLE BROOK NJ
07663-5316
US

V. Phone/Fax

Practice location:
  • Phone: 201-368-1717
  • Fax: 201-368-9619
Mailing address:
  • Phone: 201-368-1717
  • Fax: 201-368-9619

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL WIENER
Title or Position: DOCTOR
Credential: D.O.
Phone: 201-368-1717