Provider Demographics
NPI:1447580170
Name:WIESELMAN, ALEX (MA, EDS)
Entity Type:Individual
Prefix:MR
First Name:ALEX
Middle Name:
Last Name:WIESELMAN
Suffix:
Gender:M
Credentials:MA, EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 595
Mailing Address - Street 2:43 US HIGHWAY 202 FAR HILLS PROFESSIONAL BUILDING
Mailing Address - City:FAR HILLS
Mailing Address - State:NJ
Mailing Address - Zip Code:07931-0595
Mailing Address - Country:US
Mailing Address - Phone:908-781-7900
Mailing Address - Fax:862-244-4419
Practice Address - Street 1:43 US HIGHWAY 202
Practice Address - Street 2:
Practice Address - City:FAR HILLS
Practice Address - State:NJ
Practice Address - Zip Code:07931-0595
Practice Address - Country:US
Practice Address - Phone:908-781-7900
Practice Address - Fax:862-244-4419
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-31
Last Update Date:2009-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37F100150500106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist