Provider Demographics
NPI:1093949828
Name:WIENER, JOANNA
Entity Type:Individual
Prefix:
First Name:JOANNA
Middle Name:
Last Name:WIENER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:636 E 11TH ST
Mailing Address - Street 2:APT. GA
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10009-4243
Mailing Address - Country:US
Mailing Address - Phone:914-439-0239
Mailing Address - Fax:
Practice Address - Street 1:636 E 11TH ST
Practice Address - Street 2:APT. GA
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10009-4243
Practice Address - Country:US
Practice Address - Phone:914-439-0239
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-07
Last Update Date:2009-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0135781225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist