Individual
RICHARD B WISE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
54 WEST JIMMIE LEEDS RD, UNIT 15, GALLOWAY, NJ 08205-9401
(609) 652-1010
(609) 652-7759
Mailing address
54 W JIMMIE LEEDS RD # 15, GALLOWAY, NJ 08205-9401
(609) 652-1010
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
MA72455
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2398350000
AMERIHEALTH
—
01
—
3840133
AETNA HMO
—
01
—
60000622
HORIZON MERCY
NJ
05
—
8640408
—
NJ
Enumeration date
06/08/2005
Last updated
01/03/2008
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