Provider Demographics
NPI:1477646024
Name:ARTHUR J WISE MD PC
Entity Type:Organization
Organization Name:ARTHUR J WISE MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/BUSINESS OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ARTHUR
Authorized Official - Middle Name:J
Authorized Official - Last Name:WISE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-484-4100
Mailing Address - Street 1:ONE EXPRESSWAY PLAZA
Mailing Address - Street 2:SUITE 104
Mailing Address - City:ROSLYN HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11577
Mailing Address - Country:US
Mailing Address - Phone:516-484-4100
Mailing Address - Fax:516-484-4120
Practice Address - Street 1:ONE EXPRESSWAY PLAZA
Practice Address - Street 2:SUITE 104
Practice Address - City:ROSLYN HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11577
Practice Address - Country:US
Practice Address - Phone:516-484-4100
Practice Address - Fax:516-484-4120
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2010-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY097862173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYB0101Medicare UPIN
NY961391Medicare ID - Type Unspecified