Provider Demographics
NPI:1447207105
Name:WELTIN, JOHANNES D (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHANNES
Middle Name:D
Last Name:WELTIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:6 WINDMILL DR
Mailing Address - Street 2:
Mailing Address - City:MONSEY
Mailing Address - State:NY
Mailing Address - Zip Code:10952-1201
Mailing Address - Country:US
Mailing Address - Phone:845-558-2798
Mailing Address - Fax:845-354-3975
Practice Address - Street 1:38 GLENBROOK RD
Practice Address - Street 2:
Practice Address - City:MONSEY
Practice Address - State:NY
Practice Address - Zip Code:10952-1310
Practice Address - Country:US
Practice Address - Phone:845-354-9300
Practice Address - Fax:845-354-9448
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-28
Last Update Date:2023-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY140837207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01421705Medicaid
NY49A601Medicare ID - Type Unspecified
NYC10375Medicare UPIN