Provider Demographics
NPI:1710054861
Name:WIZNIA, ANDREW ALAN (MD)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:ALAN
Last Name:WIZNIA
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Gender:M
Credentials:MD
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Mailing Address - Street 1:1400 PELHAM PKWY S
Mailing Address - Street 2:JACP-5C-15
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10461-1138
Mailing Address - Country:US
Mailing Address - Phone:718-918-4664
Mailing Address - Fax:718-918-4699
Practice Address - Street 1:1400 PELHAM PKWY S
Practice Address - Street 2:JACP-5C-15
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-1138
Practice Address - Country:US
Practice Address - Phone:718-918-4664
Practice Address - Fax:718-918-4699
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-30
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
NY1502952080P0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0201XAllopathic & Osteopathic PhysiciansPediatricsPediatric Allergy/Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01107946Medicaid
NY01107946Medicaid