Provider Demographics
NPI:1457417545
Name:WEKSLER, MOSES (PHD)
Entity Type:Individual
Prefix:DR
First Name:MOSES
Middle Name:
Last Name:WEKSLER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21614 17TH AVE
Mailing Address - Street 2:
Mailing Address - City:BAYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11360-1222
Mailing Address - Country:US
Mailing Address - Phone:718-428-1037
Mailing Address - Fax:718-428-1037
Practice Address - Street 1:1455 55TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11219-4257
Practice Address - Country:US
Practice Address - Phone:718-853-3593
Practice Address - Fax:718-686-0978
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY05186103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1060710OtherBEACON HEALTH
NYNY SO 5186-B2OtherWORKER'S COMPENSATION
NY00496075Medicaid
NYP560509OtherOXFORD
NY078711OtherVALUE OPTIONS
NY1015863OtherMULTIPLER
NY0083056OtherGHI
NY5526630OtherBLUE CROSS
NY00496075Medicaid