Provider Demographics
NPI:1184650657
Name:THENOR-LOUIS, WESNER (MD)
Entity Type:Individual
Prefix:
First Name:WESNER
Middle Name:
Last Name:THENOR-LOUIS
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 1:1 FARM LN
Mailing Address - Street 2:
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11020-1313
Mailing Address - Country:US
Mailing Address - Phone:516-482-8865
Mailing Address - Fax:718-276-1474
Practice Address - Street 1:13175 234TH ST
Practice Address - Street 2:
Practice Address - City:ROSEDALE
Practice Address - State:NY
Practice Address - Zip Code:11422-1311
Practice Address - Country:US
Practice Address - Phone:718-712-3914
Practice Address - Fax:718-276-1474
Is Sole Proprietor?:No
Enumeration Date:2006-06-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY197657207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYG22758Medicare UPIN