Provider Demographics
NPI:1699850313
Name:WERZBERGER, ALAN (MD, FAAP)
Entity type:Individual
Prefix:DR
First Name:ALAN
Middle Name:
Last Name:WERZBERGER
Suffix:
Gender:M
Credentials:MD, FAAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 VAN BUREN DR
Mailing Address - Street 2:SUITE 102
Mailing Address - City:MONROE
Mailing Address - State:NY
Mailing Address - Zip Code:10950-6018
Mailing Address - Country:US
Mailing Address - Phone:845-783-0989
Mailing Address - Fax:845-782-6706
Practice Address - Street 1:22 VAN BUREN DR
Practice Address - Street 2:SUITE 102
Practice Address - City:MONROE
Practice Address - State:NY
Practice Address - Zip Code:10950-6018
Practice Address - Country:US
Practice Address - Phone:845-783-0989
Practice Address - Fax:845-782-6706
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2024-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY161432208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02510492Medicaid
NYA62936Medicare UPIN