Provider Demographics
NPI:1609182831
Name:ALAN WEISEL MD PC
Entity Type:Organization
Organization Name:ALAN WEISEL MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:
Authorized Official - Last Name:WEISEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-348-9350
Mailing Address - Street 1:70 LYNAM RD
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06903-4523
Mailing Address - Country:US
Mailing Address - Phone:203-348-9350
Mailing Address - Fax:203-569-3650
Practice Address - Street 1:47 OAK ST
Practice Address - Street 2:SECOND FLOOR
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06905-5316
Practice Address - Country:US
Practice Address - Phone:203-348-9350
Practice Address - Fax:203-569-3650
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-25
Last Update Date:2010-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT010341207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
200000075Medicare PIN
B83591Medicare UPIN