Provider Demographics
NPI:1952388845
Name:WIENER, JOSEPH MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH MICHAEL
Middle Name:
Last Name:WIENER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 95000-4145
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19195-0001
Mailing Address - Country:US
Mailing Address - Phone:212-492-5500
Mailing Address - Fax:
Practice Address - Street 1:8767 WILSHIRE BLVD FL 3
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90211-2714
Practice Address - Country:US
Practice Address - Phone:310-385-6031
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-30
Last Update Date:2023-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC161178207R00000X
NY233307207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02646537Medicaid
NYI25413Medicare UPIN
NY078SLIMedicare ID - Type Unspecified