Individual
MELVIN WIEDERKEHR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
198 FOSTER AVE, BROOKLYN, NY 11230
(718) 435-7676
(718) 871-1223
Mailing address
198 FOSTER AVE, BROOKLYN, NY 11230-2133
(718) 435-7676
(718) 871-1223
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
128407
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
128407
MEDICAL LICENSE
NY
Enumeration date
08/14/2006
Last updated
08/21/2018
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