Provider Demographics
NPI:1245751882
Name:WISE MEDICAL NY PC
Entity Type:Organization
Organization Name:WISE MEDICAL NY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELI
Authorized Official - Middle Name:
Authorized Official - Last Name:INZLICHT-SPREI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:917-415-5147
Mailing Address - Street 1:5314 16TH AVE STE 405
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11204-1425
Mailing Address - Country:US
Mailing Address - Phone:212-739-1799
Mailing Address - Fax:212-739-1793
Practice Address - Street 1:5918 18TH AVE STE 3
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11204
Practice Address - Country:US
Practice Address - Phone:212-739-1799
Practice Address - Fax:212-739-1793
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-05
Last Update Date:2019-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty