Provider Demographics
NPI:1598823502
Name:WISNIEWSKI, STEVEN J (PA)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:J
Last Name:WISNIEWSKI
Suffix:
Gender:M
Credentials:PA
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Mailing Address - Street 1:200 HYGEIA DR
Mailing Address - Street 2:CCHS INC., PHYSICIAN CONTRACTING, SUITE 2502
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19713-2049
Mailing Address - Country:US
Mailing Address - Phone:302-623-7362
Mailing Address - Fax:302-623-7374
Practice Address - Street 1:4735 OGLETOWN STANTON RD
Practice Address - Street 2:MAP II, SUITES 1201 & 1205
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19713-2072
Practice Address - Country:US
Practice Address - Phone:302-733-1980
Practice Address - Fax:302-733-1986
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
DEC5-0000561363A00000X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Not Answered363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
DEC5-0000561OtherPROFESSIONAL LICENSE