Provider Demographics
NPI:1649231317
Name:WIENER, ROY S (MD)
Entity Type:Individual
Prefix:DR
First Name:ROY
Middle Name:S
Last Name:WIENER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:140 CANAL VIEW BLVD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14623-2808
Mailing Address - Country:US
Mailing Address - Phone:585-338-2700
Mailing Address - Fax:585-242-9663
Practice Address - Street 1:140 CANAL VIEW BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14623-2808
Practice Address - Country:US
Practice Address - Phone:585-338-2700
Practice Address - Fax:585-242-9663
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY154673207UN0901X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
7701248OtherMVP
005251432OtherCOMM BLUE BCBSWNY
NY01066742Medicaid
005251432OtherHEALTH NOW PARNALL
RC60154673OtherRCIPA
060047208OtherRAILROAD MEDICARE
PO10154373OtherEXCELLUS
0000268641OtherUNITED HEALTHCARE
6890OtherBLUE CROSS BLUE SHIELD
PO10154673OtherGRIPA
9680833OtherGHI
301136OtherWELLCARE
4594557OtherAETNA
000525143003OtherHEALTH NOW LINDEN OAKS
MDC189OtherPREFERRED CARE
9680833OtherGHI
9680833OtherGHI