MEDICARE: WISE MEDICINE, PC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	2084N0400X	Neurology Physician
2	2084N0600X	Clinical Neurophysiology Physician
3	2084S0012X	Sleep Medicine (Psychiatry & Neurology) Physician

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
2	86R361	OTHER		EBCBSH

General Provider Information

NPI Number	:	1851695472
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WISE MEDICINE, PC

Provider Business Mailing Address
First Line	:	8403 CUTHBERT RD
Second Line	:	SUITE 1A
City	:	KEW GARDENS
State	:	NY
Zip	:	11415-2140
Country	:	US
Telephone Number	:	718-441-0519
Fax Number	:	718-441-0554

Provider Business Practice Location Address
First Line	:	8403 CUTHBERT RD
Second Line	:	SUITE 1A
City	:	KEW GARDENS
State	:	NY
Zip	:	11415-2140
Country	:	US
Telephone Number	:	718-441-0519
Fax Number	:	718-441-0554

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. ALCIBIADES J RODRIGUEZ
Credential	:	M.D.
Telephone Number	:	718-441-0519

Provider Enumeration Date	:	12/23/2010
Last Update Date	:	12/23/2010

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