Look up the most recent NPI and PECOS records

David Wisa

Internal Medicine

Allopathic & Osteopathic Physicians

4500 Parsons Blvd, Flushing, NY 11355-2205

PECOS Enrollment

Based on the most recent information from CMS, provider David Wisa is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Enrolled

CMS last updated its PECOS records 5 days ago.

Profile Details

Provider ID
1760773246
Provider Type
Individual
Full Name
Wisa, David
Credential
MD

Gender
Male
Sole Proprietor
No
Enumeration Date
5/2/2011
Last Updated
3/17/2018

Contact Information

Practice Location

4500 Parsons Blvd, Flushing, NY 11355-2205

(718) 670-3012

Unlisted Fax

Mailing Location

4142 24th St, 1409, Long Island City, NY 11101-4026

(585) 820-4878

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 207R00000X Primary	Description Internal Medicine Allopathic & Osteopathic Physicians	License 277100 New York
Code 207RP1001X	Description Internal Medicine Allopathic & Osteopathic Physicians	License 277100 New York

David Wisa

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

Code

Description

License

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