Individual
DR. GLORIA DIANA WISEMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
570 FORT WASHINGTON AVE, NEW YORK, NY 10033-2054
(212) 795-3293
(212) 795-3164
Mailing address
69 EDGEMONT PLACE, TEANECK, NJ 07666-4605
(201) 837-9918
(201) 837-9936
Taxonomy
Speciality
Code
Description
License number
State
2080N0001X
Neonatal-Perinatal Medicine Physician
Primary
151187
NY
2080N0001X
Neonatal-Perinatal Medicine Physician
MA47936
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00848417
—
NY
05
—
5114900
—
NJ
Enumeration date
11/20/2006
Last updated
07/08/2007
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