Organization
MARVIN WISCH PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARVIN WISCH DO (OWNER)
(201) 796-3171
Entity
Organization
Contact information
Practice address
28-09 FAIR LAWN AVE, FAIR LAWN, NJ 07410-3410
(201) 796-3171
(201) 796-8022
Mailing address
28-09 FAIR LAWN AVE, FAIR LAWN, NJ 07410-3410
(201) 796-3171
(201) 796-8022
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MB14606
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4697707
—
NJ
Enumeration date
12/28/2009
Last updated
12/28/2009
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