Provider Demographics
NPI:1710465893
Name:WESS, MICHAEL E
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:E
Last Name:WESS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 WELLINGTON RD
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11530-4148
Mailing Address - Country:US
Mailing Address - Phone:516-776-8857
Mailing Address - Fax:
Practice Address - Street 1:34 WELLINGTON RD
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:NY
Practice Address - Zip Code:11530-4148
Practice Address - Country:US
Practice Address - Phone:516-776-8857
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-01
Last Update Date:2018-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist