Individual
JEFFREY JOHN WISINSKI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Taxonomy
Speciality
Code
Description
License number
State
207QS0010X
Sports Medicine (Family Medicine) Physician
Primary
87924
SC
207QS0010X
Sports Medicine (Family Medicine) Physician
OS020477
PA
Other
Enumeration date
05/04/2016
Last updated
03/06/2023
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