Healthcare Provider Details

I. General information

NPI: 1972549525
Provider Name (Legal Business Name): WOLFGANG WEBER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2006
Last Update Date: 12/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1275 YORK AVE MSKCC MOLECULAR IMAGING AND THERAPY SERVICE
NEW YORK NY
10065-6007
US

IV. Provider business mailing address

1275 YORK AVE MSKCC - MOLECULAR IMAGING AND THERAPY SERVICE
NEW YORK NY
10065-6007
US

V. Phone/Fax

Practice location:
  • Phone: 212-639-7373
  • Fax:
Mailing address:
  • Phone: 212-639-7373
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207UN0902X
TaxonomyNuclear Imaging & Therapy Physician
License Number267163
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: