Active NPI
Ira P Wechterman, DDS
- General Practice Dentistry
- Medford, NY
National Provider Identifier
1467560110
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 26685
- Practice address
- BLDG 6 3237 Route 112
Suite 7B
Medford, NY 11763-1424 - Phone
- (631) 698-1140
- Fax
- (631) 696-3520
- NPI assigned
- Aug 25, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 26685 | NY | Primary |
Addresses
Primary practice location
BLDG 6 3237 Route 112
Suite 7B
Medford, NY 11763-1424
Mailing address
BLDG 6 3237 Route 112
Suite 7B
Medford, NY 11763-1424
Phone (631) 698-1140
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00646960 | Medicaid | NY |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 26685 | NY | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156464000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183939200000",
"number": "1467560110",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "BLDG 6 3237 ROUTE 112",
"address_2": "SUITE 7B",
"city": "MEDFORD",
"state": "NY",
"postal_code": "117631424",
"telephone_number": "631-698-1140",
"fax_number": "631-696-3520"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "BLDG 6 3237 ROUTE 112",
"address_2": "SUITE 7B",
"city": "MEDFORD",
"state": "NY",
"postal_code": "117631424",
"telephone_number": "631-698-1140",
"fax_number": "631-696-3520"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WECHTERMAN",
"first_name": "IRA",
"middle_name": "P",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-25",
"last_updated": "2007-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "NY",
"license": "26685",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00646960",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Medford, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.