Healthcare Provider Details

I. General information

NPI: 1194550707
Provider Name (Legal Business Name): JONATHAN ANTHONY WYSS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/04/2024
Last Update Date: 09/04/2024
Certification Date: 09/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

151 E 83RD ST APT 3F
NEW YORK NY
10028-1909
US

IV. Provider business mailing address

151 E 83RD ST APT 3F
NEW YORK NY
10028-1909
US

V. Phone/Fax

Practice location:
  • Phone: 646-242-2702
  • Fax:
Mailing address:
  • Phone: 646-242-2702
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: