Healthcare Provider Details

I. General information

NPI: 1013837731
Provider Name (Legal Business Name): WILLIAM KEVIN WERTLING
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2026
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

148 ELAINE DR
OCEANSIDE NY
11572-5711
US

IV. Provider business mailing address

148 ELAINE DR
OCEANSIDE NY
11572-5711
US

V. Phone/Fax

Practice location:
  • Phone: 516-993-2885
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number131845
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: