Provider Demographics
NPI:1538328810
Name:WYSOCK, JAMES STEVEN (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:STEVEN
Last Name:WYSOCK
Suffix:
Gender:M
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:5645 MAIN ST
Mailing Address - Street 2:W-LL300
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355-5045
Mailing Address - Country:US
Mailing Address - Phone:718-670-2127
Mailing Address - Fax:718-961-1853
Practice Address - Street 1:5645 MAIN ST
Practice Address - Street 2:W-LL300
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-5045
Practice Address - Country:US
Practice Address - Phone:718-445-0220
Practice Address - Fax:718-939-1167
Is Sole Proprietor?:No
Enumeration Date:2008-06-03
Last Update Date:2021-04-02
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Provider Licenses
StateLicense IDTaxonomies
NY244348208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY'03382978Medicaid
NYA400055689Medicare PIN