MEDICARE: DR. KAREN E. WIENER M.D.

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	2084P0800X	Psychiatry Physician	124243	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	124243	OTHER	NY	NY STATE MEDICAL LICENSE
2	P010124243	OTHER	NY	EXCELLUS BLUE CROSS
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	105591EU	OTHER	NY	PREFERRED CARE PROVIDER #
5	P030124243	OTHER	NY	EXCELLUS BLUE CHOICE

General Provider Information

NPI Number	:	1558330274
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KAREN E. WIENER M.D.

Provider Business Mailing Address
First Line	:	2613 WEST HENRIETTA ROAD
Second Line	:	STRONG TIES
City	:	ROCHESTER
State	:	NY
Zip	:	14623-2327
Country	:	US
Telephone Number	:	585-279-4900
Fax Number	:	585-461-9504

Provider Business Practice Location Address
First Line	:	2613 WEST HENRIETTA ROAD
Second Line	:	STRONG TIES
City	:	ROCHESTER
State	:	NY
Zip	:	14623-2327
Country	:	US
Telephone Number	:	585-279-4900
Fax Number	:	585-461-9504

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/15/2006
Last Update Date	:	03/07/2023

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