Provider Demographics
NPI:1952368276
Name:WELLENSTEIN, RENEE J (DO)
Entity type:Individual
Prefix:DR
First Name:RENEE
Middle Name:J
Last Name:WELLENSTEIN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:610 FRENCH RD
Mailing Address - Street 2:
Mailing Address - City:NEW HARTFORD
Mailing Address - State:NY
Mailing Address - Zip Code:13413-1014
Mailing Address - Country:US
Mailing Address - Phone:315-792-3686
Mailing Address - Fax:888-359-6434
Practice Address - Street 1:610 FRENCH RD
Practice Address - Street 2:
Practice Address - City:NEW HARTFORD
Practice Address - State:NY
Practice Address - Zip Code:13413-1014
Practice Address - Country:US
Practice Address - Phone:315-792-3686
Practice Address - Fax:888-359-5434
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-28
Last Update Date:2014-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT041672174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTH91488Medicare UPIN
CT160002126Medicare ID - Type Unspecified