Provider Demographics
NPI:1922298066
Name:WIYGUL, JEREMY B (MD)
Entity Type:Individual
Prefix:
First Name:JEREMY
Middle Name:B
Last Name:WIYGUL
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 1:11205 QUEENS BLVD
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-8311
Mailing Address - Country:US
Mailing Address - Phone:718-224-2644
Mailing Address - Fax:
Practice Address - Street 1:11205 QUEENS BLVD
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-8311
Practice Address - Country:US
Practice Address - Phone:718-224-2644
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-25
Last Update Date:2023-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2570562088P0231X
MA2331982088P0231X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2088P0231XAllopathic & Osteopathic PhysiciansUrologyPediatric Urology