Provider Demographics
NPI:1861814733
Name:WEXLER, ERIC MICHAEL (PA)
Entity Type:Individual
Prefix:MR
First Name:ERIC
Middle Name:MICHAEL
Last Name:WEXLER
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:165 N VILLAGE AVE
Mailing Address - Street 2:SUITE 5
Mailing Address - City:ROCKVILLE CENTRE
Mailing Address - State:NY
Mailing Address - Zip Code:11570-3761
Mailing Address - Country:US
Mailing Address - Phone:516-766-0393
Mailing Address - Fax:516-766-2405
Practice Address - Street 1:165 N VILLAGE AVE
Practice Address - Street 2:SUITE 5
Practice Address - City:ROCKVILLE CENTRE
Practice Address - State:NY
Practice Address - Zip Code:11570-3761
Practice Address - Country:US
Practice Address - Phone:516-766-0393
Practice Address - Fax:516-766-2405
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-13
Last Update Date:2014-01-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY016547363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant