Provider Demographics
NPI:1639102031
Name:WYNER, PERRY A (MD)
Entity Type:Individual
Prefix:DR
First Name:PERRY
Middle Name:A
Last Name:WYNER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 LINCOLN AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:ROCKVILLE CENTRE
Mailing Address - State:NY
Mailing Address - Zip Code:11570-5775
Mailing Address - Country:US
Mailing Address - Phone:516-536-0600
Mailing Address - Fax:513-536-0694
Practice Address - Street 1:2 LINCOLN AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:ROCKVILLE CENTRE
Practice Address - State:NY
Practice Address - Zip Code:11570-5775
Practice Address - Country:US
Practice Address - Phone:516-536-0600
Practice Address - Fax:513-536-0694
Is Sole Proprietor?:No
Enumeration Date:2006-07-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY142343-1207R00000X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Not Answered207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY72A161OtherEMPIRE BCBS
NY1226474OtherUNITED HEALTHCARE
NYAP273OtherOXFORD HEALTH PLANS
NYAP273OtherOXFORD HEALTH PLANS
NY72A161Medicare ID - Type Unspecified