Provider Demographics
NPI:1063673036
Name:WISNIEWSKI, CHERYL (DPM)
Entity Type:Individual
Prefix:DR
First Name:CHERYL
Middle Name:
Last Name:WISNIEWSKI
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:722 MANTUA PIKE
Mailing Address - Street 2:SUITE 8
Mailing Address - City:WOODBURY HEIGHTS
Mailing Address - State:NJ
Mailing Address - Zip Code:08097-1141
Mailing Address - Country:US
Mailing Address - Phone:856-384-1333
Mailing Address - Fax:856-384-1297
Practice Address - Street 1:722 MANTUA PIKE
Practice Address - Street 2:SUITE 8
Practice Address - City:WOODBURY HEIGHTS
Practice Address - State:NJ
Practice Address - Zip Code:08097-1141
Practice Address - Country:US
Practice Address - Phone:856-384-1333
Practice Address - Fax:856-384-1297
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-22
Last Update Date:2008-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00296900213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery