Individual
DR. KATHERINE WIGHTMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
181 N BELLE MEAD RD, EAST SETAUKET, NY 11733-3495
(631) 444-0624
Mailing address
PO BOX 1559, STONY BROOK, NY 11790-0989
(631) 444-0624
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
207623
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01871810
—
NY
01
—
24Z681
EMPIRE BC.BS
NY
01
—
5895678
AETNA
NY
Enumeration date
06/28/2006
Last updated
07/08/2007
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