Provider Demographics
NPI:1851807168
Name:WISCOVITCH, AILEE (MS EDSPED)
Entity type:Individual
Prefix:MR
First Name:AILEE
Middle Name:
Last Name:WISCOVITCH
Suffix:
Gender:M
Credentials:MS EDSPED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1820 CORNELIA ST
Mailing Address - Street 2:
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11385-4900
Mailing Address - Country:US
Mailing Address - Phone:347-445-0559
Mailing Address - Fax:
Practice Address - Street 1:1820 CORNELIA ST
Practice Address - Street 2:
Practice Address - City:RIDGEWOOD
Practice Address - State:NY
Practice Address - Zip Code:11385-4900
Practice Address - Country:US
Practice Address - Phone:347-445-0559
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-21
Last Update Date:2017-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist