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General NPI Number Information
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NPI Number | 1649259276
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Entity Type | Individual
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Provider Name | JAY M WEITZNER M.D.
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Gender | Male
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Dates
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Enumeration Date | 01/12/2006
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Last Update Date | 09/14/2012
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Provider Practice Location Address
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Address Line | 28 RYKOWSKI LN
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City | MIDDLETOWN
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State | NY
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Zip | 10941-4018
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Country | US
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Telephone | 845-692-3376
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Fax | 845-692-0124
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Provider Business Mailing Address
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Address Line | 28 RYKOWSKI LN
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City | MIDDLETOWN
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State | NY
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Zip | 10941-4018
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Country | US
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Telephone | 845-692-3376
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Fax | 845-692-0124
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | 166417
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License Number State | NY
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