Healthcare Provider Details

I. General information

NPI: 1326021163
Provider Name (Legal Business Name): DAVID WELTMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/25/2005
Last Update Date: 03/24/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 HOSPITAL RD.
PATCHOGUE NY
11772-0000
US

IV. Provider business mailing address

52 MAIN ST
BEDFORD HILLS NY
10507-1814
US

V. Phone/Fax

Practice location:
  • Phone: 631-387-4145
  • Fax: 631-687-4282
Mailing address:
  • Phone: 914-666-2220
  • Fax: 914-666-2987

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number170720
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier01507639
Identifier TypeMEDICAID
Identifier StateNY
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: