Healthcare Provider Details

I. General information

NPI: 1477558468
Provider Name (Legal Business Name): WARREN JEFFREY WEXELMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2005
Last Update Date: 10/30/2020
Certification Date: 10/30/2020
Deactivation Date: 03/21/2006
Reactivation Date: 03/27/2006

III. Provider practice location address

1335 OCEAN PARKWAY
BROOKLYN NY
11230
US

IV. Provider business mailing address

1335 OCEAN PARKWAY
BROOKLYN NY
11230
US

V. Phone/Fax

Practice location:
  • Phone: 718-375-1600
  • Fax: 718-375-3408
Mailing address:
  • Phone: 718-375-1600
  • Fax: 718-375-3408

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number141833
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: