1699850313 NPI number — DR. ALAN WERZBERGER M.D., F.A.A.P.

Table of content: RYAN A LEHOTAY LPC, CADCII (NPI 1841581733)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699850313 NPI number — DR. ALAN WERZBERGER M.D., F.A.A.P.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WERZBERGER
Provider First Name:
ALAN
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D., F.A.A.P.
Provider Gender Code:
M

Provider's Other Name Information

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 Information

NPI Number:
1699850313
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/15/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
22 VAN BUREN DR
Provider Second Line Business Mailing Address:
SUITE 102
Provider Business Mailing Address City Name:
MONROE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10950-6018
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
845-783-0989
Provider Business Mailing Address Fax Number:
845-782-6706

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
22 VAN BUREN DR
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
MONROE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10950-6018
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
845-783-0989
Provider Business Practice Location Address Fax Number:
845-782-6706
Provider Enumeration Date:
10/25/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208000000X , with the licence number:  161432 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 02510492 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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