Individual
MR. KEVIN MICHAEL WISE JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
AGPCNP
Contact information
Practice address
550 1ST AVE, NEW YORK, NY 10016-6402
(646) 929-7800
Mailing address
97 BOYLAN ST, STATEN ISLAND, NY 10312-1421
(646) 584-5172
Taxonomy
Speciality
Code
Description
License number
State
363LP2300X
Primary Care Nurse Practitioner
Primary
312573
NY
Other
Enumeration date
05/12/2026
Last updated
05/12/2026
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