Provider Demographics
NPI:1548255664
Name:WISHNIE, PETER A (DPM)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:A
Last Name:WISHNIE
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 WILLS WAY
Mailing Address - Street 2:
Mailing Address - City:PISCATAWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:08854-3770
Mailing Address - Country:US
Mailing Address - Phone:732-968-3833
Mailing Address - Fax:732-968-8821
Practice Address - Street 1:12 WILLS WAY
Practice Address - Street 2:
Practice Address - City:PISCATAWAY
Practice Address - State:NJ
Practice Address - Zip Code:08854-3770
Practice Address - Country:US
Practice Address - Phone:732-968-3833
Practice Address - Fax:732-968-8821
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-14
Last Update Date:2014-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00182600213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJT84823Medicare UPIN