Healthcare Provider Details

I. General information

NPI: 1457725426
Provider Name (Legal Business Name): WEIL PODIATRY OF NEW YORK LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2015
Last Update Date: 04/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4151 BROADWAY STE 4159B
NEW YORK NY
10033-3780
US

IV. Provider business mailing address

1455 E GOLF RD
DES PLAINES IL
60016-1250
US

V. Phone/Fax

Practice location:
  • Phone: 917-242-4169
  • Fax: 847-390-9345
Mailing address:
  • Phone: 847-390-7666
  • Fax: 847-390-9345

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number StateNY

VIII. Authorized Official

Name: LOWELL WEIL JR.
Title or Position: CEO
Credential: DPM
Phone: 847-390-7666