1871588582 NPI number — GRACIELA WETZLER MD

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871588582 NPI number — GRACIELA WETZLER MD

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

WETZLER

Provider First Name:

GRACIELA

Provider Middle Name:

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

MD

Provider Gender Code:

F

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:

Provider Other First Name:

Provider Other Middle Name:

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:

Provider Other Last Name Type Code:

NPI Number:

1871588582

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

07/08/2007

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

977 48TH ST

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

BROOKLYN

Provider Business Mailing Address State Name:

NY

Provider Business Mailing Address Postal Code:

11219-2919

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

718-283-8015

Provider Business Mailing Address Fax Number:

718-635-7235

Provider First Line Business Practice Location Address:

948 48TH ST

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

BROOKLYN

Provider Business Practice Location Address State Name:

NY

Provider Business Practice Location Address Postal Code:

11219-2918

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

718-283-8260

Provider Business Practice Location Address Fax Number:

718-635-7235

Provider Enumeration Date:

09/19/2005

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 2080P0206X , with the licence number:  189484 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 1000016221 . This is a "AFFINITY HEALTH" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: 189484 . This is a "HIP" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: P376609 . This is a "OXFORD HEALTH" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: 1280998 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: 189484-A15 . This is a "HEALTH FIRST" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: 520281 . This is a "EMPIRE BCBS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: 5700005 . This is a "AETNA PPO" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: BK00911-02 . This is a "AMERICHOICE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: 4C0545 . This is a "HEALTH NET" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: 01598645 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
• Identifier: 2340711 . This is a "AETNA USHC HMO" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: WG9484 . This is a "ATLANTIS HEALTH" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".