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General NPI Number Information
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NPI Number | 1639141054
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Entity Type | Individual
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Provider Name | FREDERIC ELLIOT WIEN MD
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Gender | Male
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Dates
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Enumeration Date | 02/02/2006
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Last Update Date | 04/25/2025
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Provider Practice Location Address
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Address Line | 1945 ROUTE 33
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City | NEPTUNE
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State | NJ
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Zip | 07753-4859
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Country | US
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Telephone | 732-897-2770
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Fax |
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Provider Business Mailing Address
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Address Line | 331 NEWMAN SPRINGS RD BLDG 2, STE 220
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City | RED BANK
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State | NJ
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Zip | 07701-5688
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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 |
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | NJ36940
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | 140230
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | NJ36940
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License Number State | NJ
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Taxonomy #4
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | 25MA03694000
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License Number State | NJ
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