MEDICARE: JOSEPH G WIEDERMANN MD

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	207RC0000X	Cardiovascular Disease Physician	25MA06221700	NJ
2	207RI0011X	Interventional Cardiology Physician	MTL-2017-072	GU
3	207RI0011X	Interventional Cardiology Physician	25MA06221700	NJ
4	207RI0011X	Interventional Cardiology Physician	M-2082	GU

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	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1952334542
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSEPH G WIEDERMANN MD

Provider Business Mailing Address
First Line	:	310 RIVERSIDE DR APT 310
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10025-4116
Country	:	US
Telephone Number	:	917-940-4076
Fax Number	:	212-662-0375

Provider Business Practice Location Address
First Line	:	310 RIVERSIDE DR APT 310
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10025-4116
Country	:	US
Telephone Number	:	917-940-4076
Fax Number	:	212-662-0375

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

Provider Enumeration Date	:	07/08/2006
Last Update Date	:	12/07/2021

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Directions to “ JOSEPH G WIEDERMANN MD” Practice Location

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