Provider Demographics
NPI:1174628309
Name:WEISENFELD, JOSEPH J (DPM)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:J
Last Name:WEISENFELD
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:662 STEWART AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-4219
Mailing Address - Country:US
Mailing Address - Phone:718-761-4441
Mailing Address - Fax:718-477-9156
Practice Address - Street 1:662 STEWART AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-4219
Practice Address - Country:US
Practice Address - Phone:718-761-4441
Practice Address - Fax:718-477-9156
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2689213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00414448Medicaid
NYT50866Medicare UPIN
NY00414448Medicaid