MEDICARE: GARY B WENICK M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	162047	NY
2	2080P0205X	Pediatric Endocrinology Physician	162047	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1851461214
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GARY B WENICK M.D.

Provider Business Mailing Address
First Line	:	2050 ROUTE 22
Second Line	:	SUITE 101
City	:	BREWSTER
State	:	NY
Zip	:	10509-5948
Country	:	US
Telephone Number	:	845-279-2323
Fax Number	:	845-278-2341

Provider Business Practice Location Address
First Line	:	2050 ROUTE 22
Second Line	:	SUITE 101
City	:	BREWSTER
State	:	NY
Zip	:	10509-5948
Country	:	US
Telephone Number	:	845-279-2323
Fax Number	:	845-278-2341

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/09/2006
Last Update Date	:	03/16/2016

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