Individual
MR. JACK - WIENER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
L.P., NCPSYA
Contact information
Practice address
165 WEST 66TH ST, 98 RIVERSIDE DRIVE, SUITE 1A, NEW YORK, NY 10023-1002
(212) 874-7105
Mailing address
98 RIVERSIDE DR STE 1A, NEW YORK, NY 10024-5323
(212) 724-2044
Taxonomy
Speciality
Code
Description
License number
State
102L00000X
Psychoanalyst
Primary
000453
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000453
LICENSE
NY
Enumeration date
05/02/2007
Last updated
07/08/2007
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