Provider Demographics
NPI:1184814899
Name:ES-HAGH WISEMAN MD PC
Entity Type:Organization
Organization Name:ES-HAGH WISEMAN MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ES-HAGH
Authorized Official - Middle Name:
Authorized Official - Last Name:WISEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD PC
Authorized Official - Phone:718-268-7246
Mailing Address - Street 1:21 CARY RD
Mailing Address - Street 2:
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-1517
Mailing Address - Country:US
Mailing Address - Phone:516-946-8333
Mailing Address - Fax:
Practice Address - Street 1:21 CARY RD
Practice Address - Street 2:
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-1517
Practice Address - Country:US
Practice Address - Phone:516-946-8333
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ES-HAGH WISEMAN MD PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-07-29
Last Update Date:2012-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY137450208100000X
NY0158541225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty