Provider Demographics
NPI:1538201769
Name:WISHNER, FREDERICK BEN I (DC)
Entity type:Individual
Prefix:DR
First Name:FREDERICK
Middle Name:BEN
Last Name:WISHNER
Suffix:I
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 W 42ND ST
Mailing Address - Street 2:604
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10036-7902
Mailing Address - Country:US
Mailing Address - Phone:212-704-0368
Mailing Address - Fax:212-382-3878
Practice Address - Street 1:130 W 42ND ST
Practice Address - Street 2:604
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10036-7902
Practice Address - Country:US
Practice Address - Phone:212-704-0368
Practice Address - Fax:212-382-3878
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1060111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYX01761Medicare ID - Type UnspecifiedCHIROPRACTOR