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General NPI Number Information
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NPI Number | 1538952072
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Entity Type | Individual
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Provider Name | JOSEPH WISNIESKI PA
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Gender | Male
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Dates
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Enumeration Date | 05/27/2025
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Last Update Date | 08/18/2025
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Provider Practice Location Address
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Address Line | 501 MORRIS ST
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City | CHARLESTON
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State | WV
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Zip | 25301-1326
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Country | US
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Telephone | 304-388-5432
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Fax |
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Provider Business Mailing Address
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Address Line | 85 SCARLET OAK LN APT 7
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City | CHARLESTON
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State | WV
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Zip | 25306-9180
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Country | US
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Telephone | 714-702-4052
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0200X
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Taxonomy Name | Critical Care Medicine (Internal Medicine) Physician
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License Number | 1227100
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License Number State | WV
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 3068
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License Number State | WV
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