Provider Demographics
NPI:1376385948
Name:WISNIEWSKI MEDICAL LLC
Entity type:Organization
Organization Name:WISNIEWSKI MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWN
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:WISNIEWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:814-535-7721
Mailing Address - Street 1:340 1ST ST
Mailing Address - Street 2:
Mailing Address - City:CONEMAUGH
Mailing Address - State:PA
Mailing Address - Zip Code:15909-1906
Mailing Address - Country:US
Mailing Address - Phone:814-535-7721
Mailing Address - Fax:814-535-2105
Practice Address - Street 1:340 1ST ST
Practice Address - Street 2:
Practice Address - City:CONEMAUGH
Practice Address - State:PA
Practice Address - Zip Code:15909-1906
Practice Address - Country:US
Practice Address - Phone:814-535-7721
Practice Address - Fax:814-535-2105
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-12
Last Update Date:2024-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty