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General NPI Number Information
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NPI Number | 1629757208
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Entity Type | Organization
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Legal Business Name | ITAY WISER MD PC
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Dates
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Enumeration Date | 07/12/2023
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Last Update Date | 07/12/2023
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Provider Practice Location Address
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Address Line | 535 5TH AVE FL 32
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City | NEW YORK
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State | NY
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Zip | 10017-3666
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Country | US
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Telephone | 347-947-5734
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Fax |
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Provider Business Mailing Address
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Address Line | 535 5TH AVE FL 32
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City | NEW YORK
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State | NY
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Zip | 10017-3666
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. ITAY WISER
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Credential |
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Telephone | 347-947-5734
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number |
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License Number State |
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