Provider Demographics
NPI:1811976764
Name:WENGLIN, BARRY DAVID (MD)
Entity type:Individual
Prefix:DR
First Name:BARRY
Middle Name:DAVID
Last Name:WENGLIN
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 1:56 DOYER AVE
Mailing Address - Street 2:SUITE 1-EF
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10605-1639
Mailing Address - Country:US
Mailing Address - Phone:914-948-0500
Mailing Address - Fax:914-948-0560
Practice Address - Street 1:56 DOYER AVENUE
Practice Address - Street 2:SUITE 1E-F
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10605-1639
Practice Address - Country:US
Practice Address - Phone:914-948-0500
Practice Address - Fax:914-948-0560
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-10
Last Update Date:2010-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY122977207R00000X, 207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY972751OtherEMPIRE BLUE CROSS & BLUE SHIELD
NY00231003Medicaid
NY00231003Medicaid
NYB20678Medicare UPIN