Individual
LUSSIENNE WISNIEWSKI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
314 CHRIS GAUPP DR, SUITE 101, GALLOWAY, NJ 08205-4464
(609) 404-1400
Mailing address
314 CHRIS GAUPP DR, SUITE 101, GALLOWAY, NJ 08205-4464
(609) 404-1400
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
25MA04021000
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
223524101
TAX ID
NJ
01
—
2622980000
AMERIHEALTH HMO
NJ
Enumeration date
01/17/2007
Last updated
07/08/2007
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