Individual
DR. MARK WIESEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
870 PALISADE AVE, SUITE 203, TEANECK, NJ 07666-3419
(201) 836-5655
Mailing address
870 PALISADE AVE, SUITE 203, TEANECK, NJ 07666-3419
(201) 836-5655
Taxonomy
Speciality
Code
Description
License number
State
207RE0101X
Endocrinology, Diabetes & Metabolism Physician
Primary
MA39387
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0712507
—
NJ
Enumeration date
05/25/2006
Last updated
12/31/2012
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