MEDICARE: ES-HAGH WISEMAN MD PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	0158541	NY
2	208100000X	Physical Medicine & Rehabilitation Physician	137450	NY

General Provider Information

NPI Number	:	1184814899
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ES-HAGH WISEMAN MD PC

Provider Business Mailing Address
First Line	:	21 CARY RD
Second Line	:
City	:	GREAT NECK
State	:	NY
Zip	:	11021-1517
Country	:	US
Telephone Number	:	516-946-8333
Fax Number	:

Provider Business Practice Location Address
First Line	:	21 CARY RD
Second Line	:
City	:	GREAT NECK
State	:	NY
Zip	:	11021-1517
Country	:	US
Telephone Number	:	516-946-8333
Fax Number	:

Authorized Official
Title or Position	:	DOCTOR
Name	:	DR. ES-HAGH WISEMAN
Credential	:	MD PC
Telephone Number	:	718-268-7246

Provider Enumeration Date	:	07/29/2007
Last Update Date	:	08/27/2012

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