Provider Demographics
NPI:1104567064
Name:WHEELER, JOHN
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:WHEELER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1190 FIFTH AVENUE
Mailing Address - Street 2:GUGGENHEIM PAVILION-TWO WEST
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10029
Mailing Address - Country:US
Mailing Address - Phone:212-659-6800
Mailing Address - Fax:
Practice Address - Street 1:1190 FIFTH AVENUE
Practice Address - Street 2:GUGGENHEIM PAVILION-TWO WEST
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029
Practice Address - Country:US
Practice Address - Phone:212-659-6800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-05
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program