Provider Demographics
NPI:1730358995
Name:WIENER, ALFRED (MD)
Entity type:Individual
Prefix:MR
First Name:ALFRED
Middle Name:
Last Name:WIENER
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 1:575 MADISON AVE
Mailing Address - Street 2:SUITE 1006
Mailing Address - City:NEW YORK CITY
Mailing Address - State:NY
Mailing Address - Zip Code:10022-2511
Mailing Address - Country:US
Mailing Address - Phone:917-843-0882
Mailing Address - Fax:212-605-0222
Practice Address - Street 1:575 MADISON AVE
Practice Address - Street 2:SUITE 1006
Practice Address - City:NEW YORK CITY
Practice Address - State:NY
Practice Address - Zip Code:10022-2511
Practice Address - Country:US
Practice Address - Phone:917-843-0882
Practice Address - Fax:212-605-0222
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-21
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0867592084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
AW1732507OtherFEDERAL GOVT DEA