Individual
DR. JONATHAN T WISEMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
129 BRIDGEBORO ST, RIVERSIDE, NJ 08075-3201
(856) 461-0766
(856) 461-7095
Mailing address
129 BRIDGEBORO ST, RIVERSIDE, NJ 08075-3201
(856) 461-0766
(856) 461-7095
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
25MB07242800
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2688905
—
NJ
Enumeration date
02/26/2007
Last updated
03/02/2015
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