Healthcare Provider Details

I. General information

NPI: 1326046780
Provider Name (Legal Business Name): MITCHELL I. WEILER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2005
Last Update Date: 03/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

86 CARMAN AVE
CEDARHURST NY
11516-1905
US

IV. Provider business mailing address

86 CARMAN AVE
CEDARHURST NY
11516-1905
US

V. Phone/Fax

Practice location:
  • Phone: 516-569-0500
  • Fax: 516-569-0570
Mailing address:
  • Phone: 516-569-0500
  • Fax: 516-569-0570

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number148634
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier00890588
Identifier TypeMEDICAID
Identifier StateNY
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: