Individual
LAWRENCE WIESNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
33 MITCHELL AVE, SUITE G50, BINGHAMTON, NY 13903-1674
(607) 771-2220
(607) 771-2225
Mailing address
346 GRAND AVE, JOHNSON CITY, NY 13790-2558
(607) 770-0025
(607) 729-3982
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
214997
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02263936
—
NY
Enumeration date
08/09/2005
Last updated
11/19/2011
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