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 |
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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 |
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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 |
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Provider Enumeration Date | 02/23/2007 |
Last Update Date | 01/07/2011 |
Medicare PECOS PAC ID | 2062601511 |
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Medicare Enrollment ID | O20110113001041 |
Identifier | Type | State | Issuer |
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1568597086 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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207Q00000X | Family Medicine | (* (Not Available)) | Primary |
Provider Name | Jonathan T Wiseman |
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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: Medicare Enrolled Practice Location: 302 Clay St., Riverside, NJ 08075 Phone: 856-461-7755 Fax: 856-461-2699 |