Individual
MATTHEW WIELAND
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
622 W 168TH ST, VC2 SUITE #260, NEW YORK, NY 10032-3720
(212) 305-6059
Mailing address
333 E 82ND ST, APT 2, NEW YORK, NY 10028-4159
(914) 497-1751
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
017758
NY
363AM0700X
Medical Physician Assistant
4717
CT
Other
Enumeration date
07/28/2014
Last updated
01/28/2020
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