Individual
ALLEN J WIESENFELD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2800 MARCUS AVE, LAKE SUCCESS, NY 11042-1008
(516) 622-6100
Mailing address
2800 MARCUS AVE, LAKE SUCCESS, NY 11042-1008
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
165269
NY
2085R0204X
Vascular & Interventional Radiology Physician
Primary
165269
NY
Other
Enumeration date
06/23/2006
Last updated
06/05/2008
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