Doctor Name: | JONATHAN SOLOMON WISE |
NPI Number: | 1235436031 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | |
License Number: | 020517 |
Business Practice Address: | 360 Central Ave Apt 228 Lawrence, NY - 115591695 |
Business Phone Number: | 6469427018 |
Business Fax Number: | |
Mailing Address: | 301 Sullivan Pl Apt 5k, BROOKLYN |
State: | NY |
Postal Code: | 112252965 |
Phone Number: | 6469427018 |
Fax Number: | |
NPI Enumeration Date: | 02/15/2011 |
NPI Last Update Date: | 12/22/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 235Z00000X |
License Number: | 020517 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NY |
Taxonomy Type: | Speech, Language and Hearing Service Providers |
Taxonomy Classification: | Speech-Language Pathologist |
Taxonomy Specialization: | |
Taxonomy Definition: | A speech pathologist is a person qualified by a master |