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General NPI Number Information
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NPI Number | 1689262859
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Entity Type | Organization
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Legal Business Name | NEW SPRUCE, LLC
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Dates
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Enumeration Date | 01/04/2021
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Last Update Date | 01/19/2023
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Provider Practice Location Address
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Address Line | 1150 STATE ROUTE 23
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City | CATSKILL
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State | NY
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Zip | 12414-5030
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Country | US
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Telephone | 518-947-9140
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Fax |
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Provider Business Mailing Address
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Address Line | 1150 STATE ROUTE 23
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City | CATSKILL
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State | NY
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Zip | 12414-5030
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Country | US
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Telephone | 518-947-9140
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Fax | 844-867-9062
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Authorized Official
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Title or Position | OWNER
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Name | JAMES WEIDEL
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Credential | PMHNP-BC
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Telephone | 305-790-1939
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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