Healthcare Provider Details

I. General information

NPI: 1609981463
Provider Name (Legal Business Name): IAN SAUL WITTENBERG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2006
Last Update Date: 11/30/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1650 GRAND CONCOURSE ACN-3 PEDS, 4TH FLOOR INPATIENT, 5TH FLOOR NURSERY
BRONX NY
10457-7606
US

IV. Provider business mailing address

1650 GRAND CONCOURSE DEPT OF PEDIATRICS SELWYN AVE BLDG SUITE 6D
BRONX NY
10457-7606
US

V. Phone/Fax

Practice location:
  • Phone: 718-590-1800
  • Fax: 718-518-5692
Mailing address:
  • Phone: 718-960-1415
  • Fax: 718-518-5124

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number203517
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: