Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0100X | Gastroenterologist | 143482-1 | NY |
NPI | 1033191648 |
---|---|
Provider Name | Stanley Weiselberg |
First Address | Utica, NY 13502-6313 |
Second Address | Utica, NY 13502-6313 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/11/2005 |
Last Update Date | 03/06/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00846346 | (05) | NY |
B82472 | (02) | NY |