MEDICARE: PAUL WESELEY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223E0200X	Endodontics	028741	NY

General Provider Information

NPI Number	:	1255356325
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAUL WESELEY

Provider Business Mailing Address
First Line	:	1950 E 19TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11229-3540
Country	:	US
Telephone Number	:	718-336-5202
Fax Number	:	718-336-5205

Provider Business Practice Location Address
First Line	:	1950 E 19TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11229-3540
Country	:	US
Telephone Number	:	718-336-5202
Fax Number	:	718-336-5205

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/12/2006
Last Update Date	:	07/08/2007

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Directions to “ PAUL WESELEY ” Practice Location

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