Provider Demographics
NPI:1831226307
Name:WIENER, HOWARD ERNEST (MD)
Entity type:Individual
Prefix:DR
First Name:HOWARD
Middle Name:ERNEST
Last Name:WIENER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6 BEAVERDAM DR
Mailing Address - Street 2:
Mailing Address - City:EAST BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08816-2456
Mailing Address - Country:US
Mailing Address - Phone:732-821-1830
Mailing Address - Fax:732-821-1754
Practice Address - Street 1:6 BEAVERDAM DR
Practice Address - Street 2:
Practice Address - City:EAST BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08816-2456
Practice Address - Country:US
Practice Address - Phone:732-821-1830
Practice Address - Fax:732-821-1754
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2016-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03603000208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0910201Medicaid