Basic Information
Provider Information
NPI: 1487842464
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: WIENER
FirstName: MELISSA
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 150 E 42ND ST FL 9
Address2:  
City: NEW YORK
State: NY
PostalCode: 100175699
CountryCode: US
TelephoneNumber: 6466058188
FaxNumber: 2125237410
Practice Location
Address1: 1111 AMSTERDAM AVE
Address2:  
City: NEW YORK
State: NY
PostalCode: 100251716
CountryCode: US
TelephoneNumber: 2125234000
FaxNumber: 2125237410
Other Information
ProviderEnumerationDate: 10/04/2007
LastUpdateDate: 05/14/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207RI0200X218653NYY Allopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease

No ID Information.


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