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General NPI Number Information
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NPI Number | 1760986640
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Entity Type | Individual
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Provider Name | ADINA WISE MD
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Gender | Female
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Dates
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Enumeration Date | 03/23/2018
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Last Update Date | 08/23/2022
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Provider Practice Location Address
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Address Line | 350 E 17TH ST FL 20
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City | NEW YORK
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State | NY
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Zip | 10003-3805
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Country | US
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Telephone | 347-243-8438
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Fax |
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Provider Business Mailing Address
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Address Line | 350 E 17TH ST FL 20
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City | NEW YORK
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State | NY
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Zip | 10003-3805
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Country | US
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Telephone | 347-243-8438
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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 | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | 316262-01
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License Number State | NY
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