Provider Demographics
NPI:1871588582
Name:WETZLER, GRACIELA (MD)
Entity type:Individual
Prefix:
First Name:GRACIELA
Middle Name:
Last Name:WETZLER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:977 48TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11219-2919
Mailing Address - Country:US
Mailing Address - Phone:718-283-8015
Mailing Address - Fax:718-635-7235
Practice Address - Street 1:948 48TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11219-2918
Practice Address - Country:US
Practice Address - Phone:718-283-8260
Practice Address - Fax:718-635-7235
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1894842080P0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0206XAllopathic & Osteopathic PhysiciansPediatricsPediatric Gastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1000016221OtherAFFINITY HEALTH
NY189484OtherHIP
NYP376609OtherOXFORD HEALTH
NY1280998OtherUNITED HEALTHCARE
NY189484-A15OtherHEALTH FIRST
NY520281OtherEMPIRE BCBS
NY5700005OtherAETNA PPO
NYBK00911-02OtherAMERICHOICE
NY4C0545OtherHEALTH NET
NY01598645Medicaid
NY2340711OtherAETNA USHC HMO
NYWG9484OtherATLANTIS HEALTH
NY5700005OtherAETNA PPO
NYG17514Medicare UPIN