Individual
MRS. EMILY N. WIESENTHAL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
45 READE PL, POUGHKEEPSIE, NY 12601-3947
(845) 454-8500
Mailing address
1351 ROUTE 55, SUITE 200, LAGRANGEVILLE, NY 12540-5128
(845) 475-9661
(845) 475-9938
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
012753
NY
363AS0400X
Surgical Physician Assistant
Primary
012753
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03461034
—
NY
Enumeration date
10/19/2007
Last updated
05/23/2017
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