Marvin Wisch PA

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

MB14606 Issued in NJ

Legal business name

MARVIN WISCH PA

Practice address

28-09 Fair Lawn Ave
Fair Lawn, NJ 07410-3410

Phone

(201) 796-3171

Fax

(201) 796-8022

NPI assigned

Dec 28, 2009

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Marvin Wisch, DO

Title

Owner

Phone

(201) 796-3171

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1261958400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1261958400000",
    "number": "1003146994",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "28-09 FAIR LAWN AVE",
            "city": "FAIR LAWN",
            "state": "NJ",
            "postal_code": "074103410",
            "telephone_number": "201-796-3171",
            "fax_number": "201-796-8022"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "28-09 FAIR LAWN AVE",
            "city": "FAIR LAWN",
            "state": "NJ",
            "postal_code": "074103410",
            "telephone_number": "201-796-3171",
            "fax_number": "201-796-8022"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARVIN WISCH PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-12-28",
        "last_updated": "2009-12-28",
        "status": "A",
        "authorized_official_last_name": "WISCH",
        "authorized_official_first_name": "MARVIN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "201-796-3171",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "NJ",
            "license": "MB14606",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4697707",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Melissa A Martinez
• Tina-Marie Martini, OTR
• Teresa Ann Martino, M.A
• Aleksandr Martirosov, D.O.
• Carly Marut, M.S., CCC-SLP
• Moiza M Maryam
• Laurel-Anne Lauretta Mason
• Jerise M. Massone, D.C.
• Daniel E Massoud, LMFT
• Mattea Ad PC

• Family Medicine Physician in Fair Lawn, NJ
• Providers in Fair Lawn, NJ by specialty
• Family Medicine Physician in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 28, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.