Healthcare Provider Details

I. General information

NPI: 1184650657
Provider Name (Legal Business Name): WESNER THENOR-LOUIS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2006
Last Update Date: 12/12/2024
Certification Date: 12/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13175 234TH ST
ROSEDALE NY
11422-1311
US

IV. Provider business mailing address

1 FARM LN
GREAT NECK NY
11020-1313
US

V. Phone/Fax

Practice location:
  • Phone: 718-712-3914
  • Fax: 718-276-1474
Mailing address:
  • Phone: 516-482-8865
  • Fax: 718-276-1474

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number197657
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: