Active NPI
Debra Wisniewski, PA
- Medical Physician Assistant
- Union, NJ
National Provider Identifier
1750415832
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Medical Physician Assistant
- License
- 25MP00051100
- Practice address
- 695 Chestnut St
Union, NJ 07083-7200 - Phone
- (908) 851-8602
- Fax
- (908) 686-8758
- NPI assigned
- Mar 14, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medical Physician Assistant | 363AM0700X | 25MP00051100 | NJ | Primary |
Addresses
Primary practice location
695 Chestnut St
Union, NJ 07083-7200
Mailing address
PO Box 415750
Boston, MA 02241-5750
Phone (908) 851-8602
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 25MP00051100 | Other | NJ | STATE MEDICAL LICENSE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 25MP00051100 | NJ | MD | Medical Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1173830400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1468195200000",
"number": "1750415832",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 415750",
"city": "BOSTON",
"state": "MA",
"postal_code": "022415750",
"telephone_number": "908-851-8602",
"fax_number": "908-686-8758"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "695 CHESTNUT ST",
"city": "UNION",
"state": "NJ",
"postal_code": "070837200",
"telephone_number": "908-851-8602",
"fax_number": "908-686-8758"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WISNIEWSKI",
"first_name": "DEBRA",
"credential": "PA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-03-14",
"last_updated": "2016-07-11",
"status": "A"
},
"taxonomies": [
{
"code": "363AM0700X",
"taxonomy_group": "",
"desc": "Physician Assistant, Medical",
"state": "NJ",
"license": "25MP00051100",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE MEDICAL LICENSE",
"identifier": "25MP00051100",
"state": "NJ"
}
],
"endpoints": [],
"other_names": []
}Other providers in Union, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 11, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.