Provider Demographics
NPI:1326248808
Name:MARC E WIETSCHNER MD P C
Entity Type:Organization
Organization Name:MARC E WIETSCHNER MD P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MARC
Authorized Official - Middle Name:E
Authorized Official - Last Name:WIETSCHNER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-354-2020
Mailing Address - Street 1:342 JERICHO TPKE
Mailing Address - Street 2:
Mailing Address - City:FLORAL PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11001-2108
Mailing Address - Country:US
Mailing Address - Phone:516-354-2020
Mailing Address - Fax:516-354-0400
Practice Address - Street 1:342 JERICHO TPKE
Practice Address - Street 2:
Practice Address - City:FLORAL PARK
Practice Address - State:NY
Practice Address - Zip Code:11001-2108
Practice Address - Country:US
Practice Address - Phone:516-354-2020
Practice Address - Fax:516-354-0400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-23
Last Update Date:2013-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYWXZRQ1Medicare PIN