MEDICARE: HEALTHWISE MEDICAL ASSOCIATES 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	207RN0300X	Nephrology Physician		NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1467628297
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEALTHWISE MEDICAL ASSOCIATES PC

Provider Business Mailing Address
First Line	:	76 10 34 AVE
Second Line	:
City	:	JACKSON HEIGHTS
State	:	NY
Zip	:	11372-2266
Country	:	US
Telephone Number	:	718-651-3979
Fax Number	:

Provider Business Practice Location Address
First Line	:	76 10 34 AVE
Second Line	:
City	:	JACKSON HEIGHTS
State	:	NY
Zip	:	11372-2266
Country	:	US
Telephone Number	:	718-651-3979
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DOMINIC EMEKA ONYEMA
Credential	:	MD
Telephone Number	:	718-651-3979

Provider Enumeration Date	:	05/01/2008
Last Update Date	:	05/19/2008

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