Provider Demographics
NPI:1023035789
Name:WEICHENBERG, DEBORAH (MD)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:
Last Name:WEICHENBERG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 825
Mailing Address - Street 2:PLANETARIUM STATION
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024
Mailing Address - Country:US
Mailing Address - Phone:212-769-3535
Mailing Address - Fax:212-496-1665
Practice Address - Street 1:2121 BROADWAY
Practice Address - Street 2:STE 401A
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-1786
Practice Address - Country:US
Practice Address - Phone:212-769-3535
Practice Address - Fax:212-496-1665
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2016-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY164495207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01601165Medicaid
75K791Medicare ID - Type Unspecified
E53224Medicare UPIN