Healthcare Provider Details

I. General information

NPI: 1851384804
Provider Name (Legal Business Name): ADELA WICHS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5117 15TH AVE
BROOKLYN NY
11219-3736
US

IV. Provider business mailing address

546 WESTMINSTER RD
BROOKLYN NY
11230-1409
US

V. Phone/Fax

Practice location:
  • Phone: 718-633-6033
  • Fax: 718-633-6133
Mailing address:
  • Phone: 718-287-1556
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number206127
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: