Provider Demographics
NPI:1124084405
Name:WISOTSKY, DAVID (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:WISOTSKY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 FRANKLIN ST
Mailing Address - Street 2:TENAFLY PEDIATRICS
Mailing Address - City:TENAFLY
Mailing Address - State:NJ
Mailing Address - Zip Code:07670-2005
Mailing Address - Country:US
Mailing Address - Phone:201-569-2400
Mailing Address - Fax:201-816-0136
Practice Address - Street 1:32 FRANKLIN ST
Practice Address - Street 2:TENAFLY PEDIATRICS
Practice Address - City:TENAFLY
Practice Address - State:NJ
Practice Address - Zip Code:07670-2005
Practice Address - Country:US
Practice Address - Phone:201-569-2400
Practice Address - Fax:201-816-0136
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2007-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03472400208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics