Organization
JEFFREY WANERMAN MD PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JEFFREY WANERMAN MD (OWNER)
(631) 835-5367
Entity
Organization
Contact information
Practice address
301 E MAIN ST, BAY SHORE, NY 11706-8408
(631) 835-5367
Mailing address
514 MAGNOLIA LN, DIX HILLS, NY 11746-7710
(631) 835-5367
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
164953
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
164953
NEW YORK STATE LICENSE
NY
Enumeration date
05/25/2016
Last updated
05/25/2016
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