Individual
JONATHAN DAVID WIGDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
1903 SUNSET AVE, UTICA, NY 13502-5617
(315) 624-8150
(315) 797-1537
Mailing address
2209 GENESEE STREET, BUSINESS OFFICE, UTICA, NY 13501-5930
(315) 801-3282
(315) 801-8391
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
186538
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01676544
—
NY
Enumeration date
03/31/2006
Last updated
04/05/2019
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