Individual
DR. JERRY A WIDER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
48 ROUTE 25A, SUITE 207, SMITHTOWN, NY 11787-1431
(631) 862-3800
Mailing address
22 WATERVILLE RD, WHNY MANAGED CARE, AVON, CT 06001-2066
(860) 676-7421
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
092304
NY
207VG0400X
Gynecology Physician
092304
NY
207VX0000X
Obstetrics Physician
Primary
092304
NY
Other
Enumeration date
08/30/2006
Last updated
09/11/2025
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