Healthcare Provider Details

I. General information

NPI: 1073790564
Provider Name (Legal Business Name): DR. JAMES WEIDEL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/28/2008
Last Update Date: 08/10/2022
Certification Date: 08/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1150 STATE ROUTE 23
CATSKILL NY
12414-5030
US

IV. Provider business mailing address

1150 STATE ROUTE 23
CATSKILL NY
12414-5030
US

V. Phone/Fax

Practice location:
  • Phone: 646-453-6777
  • Fax: 844-867-9062
Mailing address:
  • Phone: 646-453-6777
  • Fax: 844-867-9062

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP9263044
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number401950
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: