Provider Demographics
NPI:1750753869
Name:WIZMAN, ARYEH
Entity type:Individual
Prefix:
First Name:ARYEH
Middle Name:
Last Name:WIZMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:48 BAKERTOWN RD
Mailing Address - Street 2:SUITE 401
Mailing Address - City:MONROE
Mailing Address - State:NY
Mailing Address - Zip Code:10950-8428
Mailing Address - Country:US
Mailing Address - Phone:845-782-2300
Mailing Address - Fax:845-782-4176
Practice Address - Street 1:1 DINEV RD
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:NY
Practice Address - Zip Code:10950-6487
Practice Address - Country:US
Practice Address - Phone:845-782-7510
Practice Address - Fax:845-782-5849
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-28
Last Update Date:2016-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020121225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist