Provider Demographics
NPI:1760493787
Name:BISEN, VIWEK (DO)
Entity Type:Individual
Prefix:
First Name:VIWEK
Middle Name:
Last Name:BISEN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 RIVER ST STE 900
Mailing Address - Street 2:
Mailing Address - City:HOBOKEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07030-5990
Mailing Address - Country:US
Mailing Address - Phone:201-596-4976
Mailing Address - Fax:877-837-0412
Practice Address - Street 1:221 RIVER ST STE 900
Practice Address - Street 2:
Practice Address - City:HOBOKEN
Practice Address - State:NJ
Practice Address - Zip Code:07030-5990
Practice Address - Country:US
Practice Address - Phone:201-596-4976
Practice Address - Fax:877-837-0412
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-11
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB091467002084P0800X, 2084P0015X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0015XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychosomatic Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0305642Medicaid
NJ0305642Medicaid