Provider Demographics
NPI:1215122445
Name:WIEDER, BARUCH MICHAEL (MD)
Entity type:Individual
Prefix:DR
First Name:BARUCH
Middle Name:MICHAEL
Last Name:WIEDER
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 1:860 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10065-5856
Mailing Address - Country:US
Mailing Address - Phone:212-861-1799
Mailing Address - Fax:212-628-8736
Practice Address - Street 1:860 5TH AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10065-5856
Practice Address - Country:US
Practice Address - Phone:212-861-1799
Practice Address - Fax:212-628-8736
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-11
Last Update Date:2021-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY232337207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology