Healthcare Provider Details

I. General information

NPI: 1508853276
Provider Name (Legal Business Name): WESLEY ROLF TZALL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 09/28/2005
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

170 WILLIAM ST SUITE 814
NEW YORK NY
10038-2612
US

IV. Provider business mailing address

170 WILLIAM ST SUITE 814
NEW YORK NY
10038-2612
US

V. Phone/Fax

Practice location:
  • Phone: 212-608-7422
  • Fax: 212-312-5266
Mailing address:
  • Phone: 212-608-7422
  • Fax: 212-312-5266

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number131462
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207UN0901X
TaxonomyNuclear Cardiology Physician
License Number131462
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: