Individual
JOHN WIDMER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1173 2ND AVE, APT 3S, NEW YORK, NY 10065-8239
(631) 793-5327
Mailing address
1173 2ND AVE, APT 3S, NEW YORK, NY 10065-8239
(631) 793-5327
Taxonomy
Speciality
Code
Description
License number
State
252Y00000X
Early Intervention Provider Agency
Primary
—
—
Other
Enumeration date
07/31/2014
Last updated
07/31/2014
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