=====================================================
General NPI Number Information
=====================================================
NPI Number | 1609182831
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ALAN WEISEL MD PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/25/2010
-----------------------------------------------------
Last Update Date | 08/25/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 47 OAK ST SECOND FLOOR
-----------------------------------------------------
City | STAMFORD
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06905-5316
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-348-9350
-----------------------------------------------------
Fax | 203-569-3650
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 70 LYNAM RD
-----------------------------------------------------
City | STAMFORD
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06903-4523
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-348-9350
-----------------------------------------------------
Fax | 203-569-3650
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. ALAN WEISEL
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 203-348-9350
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207X00000X
-----------------------------------------------------
Taxonomy Name | Orthopaedic Surgery Physician
-----------------------------------------------------
License Number | 010341
-----------------------------------------------------
License Number State | CT
-----------------------------------------------------