Provider Demographics
NPI:1689750069
Name:WIENER, PAUL NEIL (PT)
Entity Type:Individual
Prefix:MR
First Name:PAUL
Middle Name:NEIL
Last Name:WIENER
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:170 PROSPECT AVE
Mailing Address - Street 2:APT 5L
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601-1858
Mailing Address - Country:US
Mailing Address - Phone:201-956-4188
Mailing Address - Fax:201-956-4893
Practice Address - Street 1:170 PROSPECT AVE STE 2
Practice Address - Street 2:
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-1834
Practice Address - Country:US
Practice Address - Phone:201-880-8303
Practice Address - Fax:201-880-4893
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-28
Last Update Date:2020-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018834-1225100000X
NJQA4003741225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJC56557Medicare UPIN
NJ550895Medicare PIN