Healthcare Provider Details

I. General information

NPI: 1457713182
Provider Name (Legal Business Name): CARA WETCHER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CARA STASZEWSKI MD

II. Dates (important events)

Enumeration Date: 03/22/2016
Last Update Date: 11/14/2023
Certification Date: 11/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

376 E MAIN ST STE 202
BAY SHORE NY
11706-8441
US

IV. Provider business mailing address

376 E MAIN ST STE 202
BAY SHORE NY
11706-8441
US

V. Phone/Fax

Practice location:
  • Phone: 631-396-7000
  • Fax:
Mailing address:
  • Phone: 631-396-7000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number302737
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License Number302737
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: