Doctor Name: | DR. MELVIN LEO WIEDMAN |
NPI Number: | 1235167206 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | MEDICAL DOCTOR |
License Number: | B02406 |
Business Practice Address: | 2110 Northern Blvd Ste. 205 Manhasset, NY - 110303502 |
Business Phone Number: | 5166271811 |
Business Fax Number: | 5166271315 |
Mailing Address: | 2110 Northern Blvd, Ste. 205 MANHASSET |
State: | NY |
Postal Code: | 110303502 |
Phone Number: | 5166271811 |
Fax Number: | 5166271315 |
NPI Enumeration Date: | 06/29/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 174400000X |
License Number: | B02406 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NY |
Taxonomy Type: | Other Service Providers |
Taxonomy Classification: | Specialist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |