Provider Demographics
NPI:1851461214
Name:WENICK, GARY B (MD)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:B
Last Name:WENICK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:2050 ROUTE 22
Mailing Address - Street 2:SUITE 101
Mailing Address - City:BREWSTER
Mailing Address - State:NY
Mailing Address - Zip Code:10509-5948
Mailing Address - Country:US
Mailing Address - Phone:845-279-2323
Mailing Address - Fax:845-278-2341
Practice Address - Street 1:2050 ROUTE 22
Practice Address - Street 2:SUITE 101
Practice Address - City:BREWSTER
Practice Address - State:NY
Practice Address - Zip Code:10509-5948
Practice Address - Country:US
Practice Address - Phone:845-279-2323
Practice Address - Fax:845-278-2341
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2016-03-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY162047208000000X, 2080P0205X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080P0205XAllopathic & Osteopathic PhysiciansPediatricsPediatric Endocrinology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01251234Medicaid
NYE28457Medicare UPIN
NY91F7306761Medicare PIN