Individual
JEFFREY SCOTT WISEMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
30 HARRISON ST STE 455, JOHNSON CITY, NY 13790-2176
(607) 763-8100
(607) 763-8048
Mailing address
346 GRAND AVE, JOHNSON CITY, NY 13790-2580
(607) 763-8100
(607) 763-8048
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
190990
NY
208C00000X
Colon & Rectal Surgery Physician
Primary
190990
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01236451
—
NY
Enumeration date
12/31/2009
Last updated
01/28/2014
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