Individual
DR. ESHAGH WISEMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
21 CARY RD, GREAT NECK, NY 11021-1517
(516) 946-8333
Mailing address
21 CARY RD, GREAT NECK, NY 11021-1517
(516) 946-8333
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
137450
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01131286
—
NY
Enumeration date
09/14/2006
Last updated
08/27/2012
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