=====================================================
General NPI Number Information
=====================================================
NPI Number | 1558851907
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | WEI WEI MD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/11/2018
-----------------------------------------------------
Last Update Date | 06/22/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1275 YORK AVE
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10065-6007
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 888-492-8401
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 303 E 60TH ST APT 24H
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10022-1563
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 216-650-0494
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number | 315201-01
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------