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General NPI Number Information
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NPI Number | 1518970888
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Entity Type | Individual
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Provider Name | SUSAN PAULINE WELGRIN M.D.
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Gender | Female
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Dates
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Enumeration Date | 08/15/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 465 WILLIS AVE
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City | WILLISTON PARK
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State | NY
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Zip | 11596-1724
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Country | US
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Telephone | 516-294-3535
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Fax | 516-294-6451
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Provider Business Mailing Address
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Address Line | 22 PEPPERMILL RD
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City | ROSLYN
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State | NY
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Zip | 11576-3106
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Country | US
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Telephone | 516-314-3688
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Fax | 516-294-6451
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 187440
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License Number State | NY
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