Provider Demographics
NPI:1467454942
Name:WISHER, MICHAEL JOSEPH (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:JOSEPH
Last Name:WISHER
Suffix:
Gender:M
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 WICKS DR
Mailing Address - Street 2:
Mailing Address - City:COMMACK
Mailing Address - State:NY
Mailing Address - Zip Code:11725-3922
Mailing Address - Country:US
Mailing Address - Phone:631-974-3229
Mailing Address - Fax:
Practice Address - Street 1:523 TOWNLINE RD STE 5
Practice Address - Street 2:
Practice Address - City:HAUPPAUGE
Practice Address - State:NY
Practice Address - Zip Code:11788-2827
Practice Address - Country:US
Practice Address - Phone:631-974-3229
Practice Address - Fax:631-759-5521
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-13
Last Update Date:2022-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF400339363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health