| Jonathan T Wiseman Do Pa | |
|
129 Bridgeboro St Riverside NJ 08075-3201 | |
| (856) 461-0766 | |
| (215) 523-9281 |
| Full Name | Jonathan T Wiseman Do Pa |
|---|---|
| Speciality | Family Medicine |
| Location | 129 Bridgeboro St, Riverside, New Jersey |
| Authorized Official Name and Position | Jonathan Wiseman (PHYSICIAN) |
| Authorized Official Contact | 8567610766 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Jonathan T Wiseman Do Pa 129 Bridgeboro St Riverside NJ 08075-3201 Ph: (856) 461-0766 | Jonathan T Wiseman Do Pa 129 Bridgeboro St Riverside NJ 08075-3201 Ph: (856) 461-0766 |
| NPI Number | 1568597086 |
|---|---|
| Provider Enumeration Date | 02/23/2007 |
| Last Update Date | 01/07/2011 |
| Medicare PECOS PAC ID | 2062601511 |
|---|---|
| Medicare Enrollment ID | O20110113001041 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1568597086 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Jonathan T Wiseman |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1063548154 PECOS PAC ID: 9931388287 Enrollment ID: I20110119000927 |
Riverdel Medical Practice, Pc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 302 Clay St., Riverside, NJ 08075 Phone: 856-461-7755 Fax: 856-461-2699 |