Provider Demographics
NPI:1982475315
Name:WIENER, ALEXANDER LEWIS
Entity Type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:LEWIS
Last Name:WIENER
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 1:8315 LEFFERTS BLVD APT 5B
Mailing Address - Street 2:
Mailing Address - City:KEW GARDENS
Mailing Address - State:NY
Mailing Address - Zip Code:11415-2536
Mailing Address - Country:US
Mailing Address - Phone:617-519-3608
Mailing Address - Fax:
Practice Address - Street 1:8315 LEFFERTS BLVD APT 5B
Practice Address - Street 2:
Practice Address - City:KEW GARDENS
Practice Address - State:NY
Practice Address - Zip Code:11415-2536
Practice Address - Country:US
Practice Address - Phone:617-519-3608
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-15
Last Update Date:2024-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374K00000XNursing Service Related ProvidersReligious Nonmedical Practitioner