Provider Demographics
NPI:1558330274
Name:WIENER, KAREN E (MD)
Entity Type:Individual
Prefix:DR
First Name:KAREN
Middle Name:E
Last Name:WIENER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:2613 WEST HENRIETTA ROAD
Mailing Address - Street 2:STRONG TIES
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14623-2327
Mailing Address - Country:US
Mailing Address - Phone:585-279-4900
Mailing Address - Fax:585-461-9504
Practice Address - Street 1:2613 WEST HENRIETTA ROAD
Practice Address - Street 2:STRONG TIES
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14623-2327
Practice Address - Country:US
Practice Address - Phone:585-279-4900
Practice Address - Fax:585-461-9504
Is Sole Proprietor?:No
Enumeration Date:2006-03-15
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY1242432084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY124243OtherNY STATE MEDICAL LICENSE
NYP010124243OtherEXCELLUS BLUE CROSS
NY00850555Medicaid
NY105591EUOtherPREFERRED CARE PROVIDER #
NYP030124243OtherEXCELLUS BLUE CHOICE
NYP030124243OtherEXCELLUS BLUE CHOICE
NYP010124243OtherEXCELLUS BLUE CROSS
NY105591EUOtherPREFERRED CARE PROVIDER #