Individual
ANDREA WISSICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
177 OKARA DR W, SCHENECTADY, NY 12303-5722
(518) 416-6301
Mailing address
177 OKARA DR W, SCHENECTADY, NY 12303-5722
(518) 416-6301
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
821920
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
DZ61649C
—
NY
Enumeration date
11/08/2013
Last updated
11/08/2013
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