Provider Demographics
NPI:1124265830
Name:JERRY WEISFOGEL, M.D. P.C.
Entity type:Organization
Organization Name:JERRY WEISFOGEL, M.D. P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:WEISFOGEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-369-8639
Mailing Address - Street 1:152 EAST 84TH STREET
Mailing Address - Street 2:1JA
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10028
Mailing Address - Country:US
Mailing Address - Phone:212-369-8639
Mailing Address - Fax:
Practice Address - Street 1:152 EAST 84TH STREET
Practice Address - Street 2:1JA
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10028
Practice Address - Country:US
Practice Address - Phone:212-369-8639
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-16
Last Update Date:2009-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty