Provider Demographics
NPI:1326046780
Name:WEILER, MITCHELL I (MD)
Entity Type:Individual
Prefix:DR
First Name:MITCHELL
Middle Name:I
Last Name:WEILER
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 1:86 CARMAN AVE
Mailing Address - Street 2:
Mailing Address - City:CEDARHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11516-1905
Mailing Address - Country:US
Mailing Address - Phone:516-569-0500
Mailing Address - Fax:516-569-0570
Practice Address - Street 1:86 CARMAN AVE
Practice Address - Street 2:
Practice Address - City:CEDARHURST
Practice Address - State:NY
Practice Address - Zip Code:11516-1905
Practice Address - Country:US
Practice Address - Phone:516-569-0500
Practice Address - Fax:516-569-0570
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-11
Last Update Date:2012-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY148634208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00890588Medicaid
B20216Medicare UPIN
NY00890588Medicaid