Provider Demographics
NPI:1831348127
Name:HEALTHWISE MEDICAL ASSOCIATES, PC
Entity type:Organization
Organization Name:HEALTHWISE MEDICAL ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DOMINIC
Authorized Official - Middle Name:EMEKA
Authorized Official - Last Name:ONYEMA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-686-5782
Mailing Address - Street 1:401 E 34TH ST
Mailing Address - Street 2:STE SOUTH 35-D
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-4914
Mailing Address - Country:US
Mailing Address - Phone:212-686-5782
Mailing Address - Fax:212-532-6881
Practice Address - Street 1:1250 SHAKESPEARE AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10452-3012
Practice Address - Country:US
Practice Address - Phone:718-992-3900
Practice Address - Fax:718-537-6180
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-11
Last Update Date:2008-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY190077207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYF70005Medicare UPIN