Provider Demographics
NPI:1700153061
Name:INFECTIOUS DISEASE ASSOCIATE, PLLC
Entity Type:Organization
Organization Name:INFECTIOUS DISEASE ASSOCIATE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WEHBEH
Authorized Official - Middle Name:A
Authorized Official - Last Name:WEHBEH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:917-373-9036
Mailing Address - Street 1:5 BREWSTER ST UNIT 2NO106
Mailing Address - Street 2:
Mailing Address - City:GLEN COVE
Mailing Address - State:NY
Mailing Address - Zip Code:11542-2549
Mailing Address - Country:US
Mailing Address - Phone:917-373-9036
Mailing Address - Fax:
Practice Address - Street 1:3016 30TH DR
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11102-1874
Practice Address - Country:US
Practice Address - Phone:347-757-0821
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-30
Last Update Date:2011-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY231548207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty