MEDICARE: REGINALD WEISSGLAS 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	207L00000X	Anesthesiology Physician	218146	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1907T1	OTHER	NY	EMPIRE BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	1907T2	OTHER	NY	EMPIRE BCBS

General Provider Information

NPI Number	:	1922042928
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REGINALD WEISSGLAS MD

Provider Business Mailing Address
First Line	:	PO BOX 7096
Second Line	:
City	:	STOCKTON
State	:	CA
Zip	:	95267-0096
Country	:	US
Telephone Number	:	209-956-7725
Fax Number	:	209-956-7733

Provider Business Practice Location Address
First Line	:	9002 QUEENS BLVD
Second Line	:
City	:	ELMHURST
State	:	NY
Zip	:	11373-4941
Country	:	US
Telephone Number	:	718-558-1870
Fax Number	:	718-558-1202

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

Provider Enumeration Date	:	06/16/2006
Last Update Date	:	09/09/2008

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