Provider Demographics
NPI:1659727006
Name:WEGMANN, ANA
Entity Type:Individual
Prefix:
First Name:ANA
Middle Name:
Last Name:WEGMANN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 CHAPEL GATE
Mailing Address - Street 2:
Mailing Address - City:GLEN HEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11545-2701
Mailing Address - Country:US
Mailing Address - Phone:516-776-4197
Mailing Address - Fax:516-621-1306
Practice Address - Street 1:17 CHAPEL GATE LANE
Practice Address - Street 2:
Practice Address - City:GLEN HEAD
Practice Address - State:NY
Practice Address - Zip Code:11545
Practice Address - Country:US
Practice Address - Phone:516-776-4197
Practice Address - Fax:516-621-1306
Is Sole Proprietor?:No
Enumeration Date:2016-05-04
Last Update Date:2016-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY585619941174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist