Provider Demographics
NPI:1982629416
Name:WISNIVESKY, JUAN P (MD)
Entity Type:Individual
Prefix:
First Name:JUAN
Middle Name:P
Last Name:WISNIVESKY
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1 GUSTAVE LEVY PLACE
Mailing Address - Street 2:BOX 3000
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10029-6574
Mailing Address - Country:US
Mailing Address - Phone:212-987-3100
Mailing Address - Fax:212-731-5220
Practice Address - Street 1:5 EAST 98TH. STREET
Practice Address - Street 2:10TH. FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029-6574
Practice Address - Country:US
Practice Address - Phone:212-241-2125
Practice Address - Fax:212-731-5220
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2014-01-27
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Provider Licenses
StateLicense IDTaxonomies
NY203568207R00000X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY18U591Medicare ID - Type Unspecified
NYG88881Medicare UPIN