Provider Demographics
NPI:1720151236
Name:WECHSLER, MICHAEL HARVEY (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:HARVEY
Last Name:WECHSLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:161 FT WASHINGTON AVE
Mailing Address - Street 2:ROOM 324
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10032
Mailing Address - Country:US
Mailing Address - Phone:212-305-5311
Mailing Address - Fax:212-305-0780
Practice Address - Street 1:161 FT WASHINGTON AVE
Practice Address - Street 2:ROOM 324
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032
Practice Address - Country:US
Practice Address - Phone:212-305-5311
Practice Address - Fax:212-305-0780
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY096245208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
B78051Medicare UPIN
NY579621Medicare ID - Type Unspecified