Individual
WISMICK CONSTANT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
49 ELSTON ST, BLOOMFIELD, NJ 07003-3911
(973) 767-6953
Mailing address
49 ELSTON ST, BLOOMFIELD, NJ 07003-3911
(973) 767-6953
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
304491
NY
Other
Enumeration date
10/10/2011
Last updated
10/10/2011
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