Wiesen, Mark

Wiesen, Mark is an individual health care provider with primary practice located at 870 Palisade Ave Suite 203, Teaneck NJ 07666-3419. He recently has only one registered license in Allopathic & Osteopathic Physicians / Endocrinology, Diabetes & Metabolism, which is considered as his primary health care specialty. Wiesen, Mark can be contacted via phone (201) 836-5655.

Contact Information

Primary practice address
870 Palisade Ave Suite 203 Teaneck NJ 07666-3419
Phone: (201) 836-5655
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Endocrinology, Diabetes & Metabolism 207RE0101X MA39387 New Jersey

Profile Details

NPI number 1053367912
LBN Legal business name Wiesen, Mark
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date May 25th, 2006
Last updated Dec 31st, 2012 - about 13 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1053367912 NPPES
New Jersey MEDICAID 0712507

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