Individual
ERICA WISELY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
100 WOODS RD, VALHALLA, NY 10595-1530
(914) 493-7000
Mailing address
630 W 168TH ST, NEW YORK, NY 10032-3725
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
018538
NY
Other
Enumeration date
03/23/2015
Last updated
09/15/2020
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