Provider Demographics
NPI:1477558468
Name:WEXELMAN, WARREN JEFFREY (MD)
Entity Type:Individual
Prefix:DR
First Name:WARREN
Middle Name:JEFFREY
Last Name:WEXELMAN
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 1:1335 OCEAN PARKWAY
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11230
Mailing Address - Country:US
Mailing Address - Phone:718-375-1600
Mailing Address - Fax:718-375-3408
Practice Address - Street 1:1335 OCEAN PARKWAY
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11230
Practice Address - Country:US
Practice Address - Phone:718-375-1600
Practice Address - Fax:718-375-3408
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-16
Last Update Date:2020-10-30
Deactivation Date:2006-03-21
Deactivation Code:
Reactivation Date:2006-03-27
Provider Licenses
StateLicense IDTaxonomies
NY141833207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00838528Medicaid
NY25A681Medicare ID - Type Unspecified
A61545Medicare UPIN