Provider Demographics
NPI:1205866670
Name:WIEDERSHINE, DONN JAY (MD)
Entity Type:Individual
Prefix:DR
First Name:DONN
Middle Name:JAY
Last Name:WIEDERSHINE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3198 GRAND CONCOURSE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10458-1000
Mailing Address - Country:US
Mailing Address - Phone:718-618-0401
Mailing Address - Fax:718-795-4394
Practice Address - Street 1:2015 GRAND CONCOURSE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10453-4303
Practice Address - Country:US
Practice Address - Phone:718-299-7295
Practice Address - Fax:718-299-6797
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2015-05-12
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Provider Licenses
StateLicense IDTaxonomies
NY1664332084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY7Q2061Medicare PIN
NY7Q2061Medicare ID - Type Unspecified