Individual
DR. MICHAEL I WIENER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
1124 E RIDGEWOOD AVE STE 201, RIDGEWOOD, NJ 07450-3943
(201) 881-7282
Mailing address
514 LYDIA LN, WYCKOFF, NJ 07481-1711
(201) 891-7793
(201) 368-9618
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
25MB03506400
NJ
207Q00000X
Family Medicine Physician
AW8163812
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1569309
—
NJ
Enumeration date
08/31/2005
Last updated
12/03/2024
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