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Individual
MR. ADAM JASON WIESENTHAL
Active
Individual
MR. ADAM JASON WIESENTHAL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
012686
NY
363AS0400X
Surgical Physician Assistant
002057
CT
363AS0400X
Surgical Physician Assistant
Primary
012686-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03315184
—
NY
Enumeration date
08/27/2007
Last updated
06/06/2022
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