Provider Demographics
NPI:1366167769
Name:LAUREN E WIZNIA MD PLLC
Entity type:Organization
Organization Name:LAUREN E WIZNIA MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LAUREN
Authorized Official - Middle Name:
Authorized Official - Last Name:WIZNIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-430-6650
Mailing Address - Street 1:1016 5TH AVE STE 1D
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10028-0132
Mailing Address - Country:US
Mailing Address - Phone:203-430-6650
Mailing Address - Fax:
Practice Address - Street 1:1016 5TH AVE STE 1D
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10028-0132
Practice Address - Country:US
Practice Address - Phone:917-397-0370
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-07
Last Update Date:2022-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty