Healthcare Provider Details

I. General information

NPI: 1518014349
Provider Name (Legal Business Name): HARRIET E WIEDER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2007
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

503 GRASSLANDS RD STE 200
VALHALLA NY
10595-1593
US

IV. Provider business mailing address

22 SAW MILL RIVER RD. 2ND FLOOR
HAWTHORNE NY
10532-1549
US

V. Phone/Fax

Practice location:
  • Phone: 914-304-5250
  • Fax: 914-345-1752
Mailing address:
  • Phone: 914-593-1678
  • Fax: 914-593-1790

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number162962
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code2080P0006X
TaxonomyDevelopmental - Behavioral Pediatrics Physician
License Number56400
License Number StateCT
# 3
Primary TaxonomyY
Taxonomy Code2080P0006X
TaxonomyDevelopmental - Behavioral Pediatrics Physician
License Number162962
License Number StateNY

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: