Provider Demographics
NPI:1033191648
Name:WEISELBERG, STANLEY (MD)
Entity Type:Individual
Prefix:
First Name:STANLEY
Middle Name:
Last Name:WEISELBERG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 BUSINESS PARK DRIVE
Mailing Address - Street 2:1ST FLOOR
Mailing Address - City:UTICA
Mailing Address - State:NY
Mailing Address - Zip Code:13502-6313
Mailing Address - Country:US
Mailing Address - Phone:315-624-7000
Mailing Address - Fax:315-793-1129
Practice Address - Street 1:116 BUSINESS PARK DRIVE
Practice Address - Street 2:1ST FLOOR
Practice Address - City:UTICA
Practice Address - State:NY
Practice Address - Zip Code:13502-6313
Practice Address - Country:US
Practice Address - Phone:315-624-7000
Practice Address - Fax:315-793-1129
Is Sole Proprietor?:No
Enumeration Date:2005-11-18
Last Update Date:2020-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY143482-1207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00846346Medicaid
NYB82472Medicare UPIN
NY00846346Medicaid