Healthcare Provider Details

I. General information

NPI: 1447207105
Provider Name (Legal Business Name): JOHANNES D WELTIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/28/2006
Last Update Date: 05/07/2023
Certification Date: 04/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

38 GLENBROOK RD
MONSEY NY
10952-1310
US

IV. Provider business mailing address

6 WINDMILL DR
MONSEY NY
10952-1201
US

V. Phone/Fax

Practice location:
  • Phone: 845-354-9300
  • Fax: 845-354-9448
Mailing address:
  • Phone: 845-558-2798
  • Fax: 845-354-3975

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number140837
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: