MEDICARE: ALEXANDER LEWIS WIENER

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	374K00000X	Religious Nonmedical Practitioner

General Provider Information

NPI Number	:	1982475315
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEXANDER LEWIS WIENER

Provider Business Mailing Address
First Line	:	8315 LEFFERTS BLVD APT 5B
Second Line	:
City	:	KEW GARDENS
State	:	NY
Zip	:	11415-2536
Country	:	US
Telephone Number	:	617-519-3608
Fax Number	:

Provider Business Practice Location Address
First Line	:	8315 LEFFERTS BLVD APT 5B
Second Line	:
City	:	KEW GARDENS
State	:	NY
Zip	:	11415-2536
Country	:	US
Telephone Number	:	617-519-3608
Fax Number	:

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

Provider Enumeration Date	:	01/15/2024
Last Update Date	:	01/15/2024

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