Provider Demographics
NPI:1326769944
Name:WISE, BENJIMIN JR
Entity Type:Individual
Prefix:
First Name:BENJIMIN
Middle Name:
Last Name:WISE
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2888 MOGADORE RD APT C7
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44312-1743
Mailing Address - Country:US
Mailing Address - Phone:330-904-3644
Mailing Address - Fax:
Practice Address - Street 1:2888 MOGADORE RD APT C7
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44312-1743
Practice Address - Country:US
Practice Address - Phone:330-904-3644
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-12
Last Update Date:2022-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator