Individual
MATTHEW T WIZA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
6668 FOURTH SECTION ROAD, BROCKPORT, NY 14420
(585) 368-6870
(585) 368-6871
Mailing address
100 KINGS HWY S, ROCHESTER, NY 14617-5504
(585) 922-0553
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
235386
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02641165
—
NY
Enumeration date
07/03/2006
Last updated
04/28/2021
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