Healthcare Provider Details

I. General information

NPI: 1255316121
Provider Name (Legal Business Name): SETH WILENTZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2005
Last Update Date: 03/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 UNION SQ E SUITE 3C
NEW YORK NY
10003-3314
US

IV. Provider business mailing address

PO BOX 95000-2233
PHILADELPHIA PA
19195-2233
US

V. Phone/Fax

Practice location:
  • Phone: 212-844-8800
  • Fax:
Mailing address:
  • Phone: 212-844-8800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZD0900X
TaxonomyDermatopathology (Pathology) Physician
License Number234923
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number234923
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License Number234923
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code207NP0225X
TaxonomyPediatric Dermatology Physician
License Number234923
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: