Individual
DEBRA WISNIEWSKI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
695 CHESTNUT ST, UNION, NJ 07083-7200
(908) 851-8602
(908) 686-8758
Mailing address
PO BOX 415750, BOSTON, MA 02241-5750
(908) 851-8602
(908) 686-8758
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
25MP00051100
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
25MP00051100
STATE MEDICAL LICENSE
NJ
Enumeration date
03/14/2007
Last updated
07/11/2016
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