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	190077	NY

General Provider Information

NPI Number	:	1831348127
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEALTHWISE MEDICAL ASSOCIATES, PC

Provider Business Mailing Address
First Line	:	401 E 34TH ST
Second Line	:	STE SOUTH 35-D
City	:	NEW YORK
State	:	NY
Zip	:	10016-4914
Country	:	US
Telephone Number	:	212-686-5782
Fax Number	:	212-532-6881

Provider Business Practice Location Address
First Line	:	1250 SHAKESPEARE AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10452-3012
Country	:	US
Telephone Number	:	718-992-3900
Fax Number	:	718-537-6180

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. DOMINIC EMEKA ONYEMA
Credential	:	M.D.
Telephone Number	:	212-686-5782

Provider Enumeration Date	:	09/11/2008
Last Update Date	:	09/12/2008

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