MEDICARE: DR. WAYNE HOWARD WERTHEIM MD

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	207R00000X	Internal Medicine Physician	137692	NY

General Provider Information

NPI Number	:	1316123847
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WAYNE HOWARD WERTHEIM MD

Provider Business Mailing Address
First Line	:	PO BOX 699
Second Line	:
City	:	MELVILLE
State	:	NY
Zip	:	11747-0699
Country	:	US
Telephone Number	:	516-299-5500
Fax Number	:	516-280-2137

Provider Business Practice Location Address
First Line	:	118 GLEN COVE RD
Second Line	:
City	:	ROSLYN HEIGHTS
State	:	NY
Zip	:	11577-1718
Country	:	US
Telephone Number	:	516-299-5500
Fax Number	:	516-280-2137

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

Provider Enumeration Date	:	01/15/2008
Last Update Date	:	01/15/2008

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