Healthcare Provider Details

I. General information

NPI: 1568099349
Provider Name (Legal Business Name): JOSHUA BENJAMIN WIENER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2020
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 S 11TH ST
PHILADELPHIA PA
19107-4870
US

IV. Provider business mailing address

925 CHESTNUT ST FL 2
PHILADELPHIA PA
19107-4215
US

V. Phone/Fax

Practice location:
  • Phone: 215-955-6000
  • Fax:
Mailing address:
  • Phone: 215-955-5050
  • Fax: 215-503-5874

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberMD481613
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: