Provider Demographics
NPI:1467628297
Name:HEALTHWISE MEDICAL ASSOCIATES PC
Entity Type:Organization
Organization Name:HEALTHWISE MEDICAL ASSOCIATES PC
Other - Org Name:HEALTHWISE MEDICAL ASSOC
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DOMINIC
Authorized Official - Middle Name:EMEKA
Authorized Official - Last Name:ONYEMA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-651-3979
Mailing Address - Street 1:76 10 34 AVE
Mailing Address - Street 2:
Mailing Address - City:JACKSON HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11372-2266
Mailing Address - Country:US
Mailing Address - Phone:718-651-3979
Mailing Address - Fax:
Practice Address - Street 1:76 10 34 AVE
Practice Address - Street 2:
Practice Address - City:JACKSON HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11372-2266
Practice Address - Country:US
Practice Address - Phone:718-651-3979
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-01
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01624244Medicaid
NYF70005Medicare UPIN