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General NPI Number Information
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NPI Number | 1679992036
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Entity Type | Individual
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Provider Name | MR. RUSSELL WEG
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Gender | Male
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Dates
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Enumeration Date | 04/15/2014
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Last Update Date | 01/25/2021
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Provider Practice Location Address
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Address Line | 7136 110TH ST STE 1G
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City | FOREST HILLS
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State | NY
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Zip | 11375-4852
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Country | US
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Telephone | 718-520-2210
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Fax |
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Provider Business Mailing Address
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Address Line | 7136 110TH ST STE 1G
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City | FOREST HILLS
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State | NY
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Zip | 11375-4852
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Country | US
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Telephone | 718-520-2210
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Fax | 718-520-4448
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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 | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | 291260-1
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License Number State | NY
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