Provider Demographics
NPI:1619940467
Name:WURM, EMANUEL IRA (DO)
Entity Type:Individual
Prefix:DR
First Name:EMANUEL
Middle Name:IRA
Last Name:WURM
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 WESTCHESTER AVE
Mailing Address - Street 2:3RD FL
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10604-2901
Mailing Address - Country:US
Mailing Address - Phone:914-681-3146
Mailing Address - Fax:914-682-6403
Practice Address - Street 1:210 WESTCHESTER AVE
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10604-2901
Practice Address - Country:US
Practice Address - Phone:914-682-6511
Practice Address - Fax:914-682-6403
Is Sole Proprietor?:No
Enumeration Date:2006-02-10
Last Update Date:2013-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1994120207RC0200X
CT042970207RC0200X, 207RP1001X
NY194120207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01936098/02338970Medicaid
NYG69046Medicare UPIN
CT290000407Medicare ID - Type Unspecified
NY80L971/W2L683Medicare ID - Type Unspecified