Provider Demographics
NPI:1811163074
Name:WIENER, STANLEY LAWRENCE (MD)
Entity type:Individual
Prefix:DR
First Name:STANLEY
Middle Name:LAWRENCE
Last Name:WIENER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:STANLEY
Other - Middle Name:LAWRENCE
Other - Last Name:WIENER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:P O BOX 4059
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:17474
Mailing Address - Country:US
Mailing Address - Phone:201-262-0075
Mailing Address - Fax:
Practice Address - Street 1:555 KINDERKAMACK RD
Practice Address - Street 2:
Practice Address - City:ORADELL
Practice Address - State:NJ
Practice Address - Zip Code:07649-1517
Practice Address - Country:US
Practice Address - Phone:201-262-0075
Practice Address - Fax:201-262-9440
Is Sole Proprietor?:No
Enumeration Date:2008-05-07
Last Update Date:2008-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJAW9156539207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJC61385Medicare UPIN