Provider Demographics
NPI:1871517300
Name:WEISENFELD, LORI S (DPM)
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:S
Last Name:WEISENFELD
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:161 MADISON AVE
Mailing Address - Street 2:SUITE 7NE
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-5421
Mailing Address - Country:US
Mailing Address - Phone:212-947-2320
Mailing Address - Fax:212-239-9784
Practice Address - Street 1:161 MADISON AVE
Practice Address - Street 2:SUITE 7NE
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-5421
Practice Address - Country:US
Practice Address - Phone:212-947-2320
Practice Address - Fax:212-239-9784
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2021-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN004439213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP53021Medicare ID - Type Unspecified
T96014Medicare UPIN