Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | 040254-01 | NY |
NPI | 1073559746 |
---|---|
Provider Name | Dr. Evan Scott Wetzler |
First Address | Yorktown Heights, NY 10598-4130 |
Second Address | Yorktown Heights, NY 10598-4130 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/06/2006 |
Last Update Date | 08/07/2007 |