Provider Demographics
NPI:1861413395
Name:WISZNIAK, JOEL (MD)
Entity type:Individual
Prefix:
First Name:JOEL
Middle Name:
Last Name:WISZNIAK
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 1:601 N. FEDERAL HIGHWAY
Mailing Address - Street 2:STE 401
Mailing Address - City:HALLANDALE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33009-2106
Mailing Address - Country:US
Mailing Address - Phone:954-454-1066
Mailing Address - Fax:954-456-4025
Practice Address - Street 1:601 N. FEDERAL HIGHWAY
Practice Address - Street 2:STE 401
Practice Address - City:HALLANDALE BEACH
Practice Address - State:FL
Practice Address - Zip Code:33009-2106
Practice Address - Country:US
Practice Address - Phone:954-454-1066
Practice Address - Fax:954-456-4025
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2024-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME53127207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0479110Medicaid
FL05782Medicare ID - Type Unspecified
FL0479110Medicaid