Provider Demographics
NPI:1962410878
Name:WERRELL, ALBERT JOSEPH (MD)
Entity type:Individual
Prefix:DR
First Name:ALBERT
Middle Name:JOSEPH
Last Name:WERRELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6 PINE TREE PL
Mailing Address - Street 2:
Mailing Address - City:WEST CALDWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:07006-7328
Mailing Address - Country:US
Mailing Address - Phone:718-336-6667
Mailing Address - Fax:718-336-1117
Practice Address - Street 1:2222 CONEY ISLAND AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11223-3338
Practice Address - Country:US
Practice Address - Phone:718-336-6667
Practice Address - Fax:718-336-1117
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2008-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1954731207R00000X, 207U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207U00000XAllopathic & Osteopathic PhysiciansNuclear Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01497149Medicaid
F97362Medicare UPIN
AW057J2510Medicare ID - Type Unspecified