Healthcare Provider Details

I. General information

NPI: 1619940467
Provider Name (Legal Business Name): EMANUEL IRA WURM DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/10/2006
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

342 ROUTE 202
SOMERS NY
10589-3207
US

IV. Provider business mailing address

342 ROUTE 202
SOMERS NY
10589-3207
US

V. Phone/Fax

Practice location:
  • Phone: 845-725-0222
  • Fax:
Mailing address:
  • Phone: 845-725-0222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number1994120
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number042970
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number042970
License Number StateCT
# 4
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number194120
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: