Provider Demographics
NPI:1154521458
Name:MARK R. WEIGLE, MD, P.C.
Entity type:Organization
Organization Name:MARK R. WEIGLE, MD, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:R
Authorized Official - Last Name:WEIGLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:914-636-4466
Mailing Address - Street 1:140A LOCKWOOD AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:NEW ROCHELLE
Mailing Address - State:NY
Mailing Address - Zip Code:10801-4915
Mailing Address - Country:US
Mailing Address - Phone:914-636-4466
Mailing Address - Fax:914-636-0611
Practice Address - Street 1:140A LOCKWOOD AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:NEW ROCHELLE
Practice Address - State:NY
Practice Address - Zip Code:10801-4915
Practice Address - Country:US
Practice Address - Phone:914-636-4466
Practice Address - Fax:914-636-0611
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-24
Last Update Date:2010-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY211099174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY6306090001Medicare NSC