Provider Demographics
NPI:1528122314
Name:MOISE, WESNER (MD)
Entity type:Individual
Prefix:DR
First Name:WESNER
Middle Name:
Last Name:MOISE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:MRS
Other - First Name:MIREILLE
Other - Middle Name:
Other - Last Name:MOISE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:248 W 35TH ST
Mailing Address - Street 2:8TH FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10001-2505
Mailing Address - Country:US
Mailing Address - Phone:855-681-8700
Mailing Address - Fax:646-380-1322
Practice Address - Street 1:2412 CHURCH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11226-4005
Practice Address - Country:US
Practice Address - Phone:855-681-8700
Practice Address - Fax:646-380-1322
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2016-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY121660207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00228428Medicaid
NYA400154275Medicare UPIN
NY00228428Medicaid