Provider Demographics
NPI:1053327015
Name:WEISS, DEBORAH J (MD)
Entity Type:Individual
Prefix:DR
First Name:DEBORAH
Middle Name:J
Last Name:WEISS
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 1:222 E MIDDLE COUNTRY RD STE 330
Mailing Address - Street 2:
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-2814
Mailing Address - Country:US
Mailing Address - Phone:631-393-1670
Mailing Address - Fax:631-382-8941
Practice Address - Street 1:222 E MIDDLE COUNTRY RD STE 330
Practice Address - Street 2:
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-2814
Practice Address - Country:US
Practice Address - Phone:631-393-1670
Practice Address - Fax:631-382-8941
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2023-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY211567-1207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY59C141Medicare ID - Type Unspecified
NYH13121Medicare UPIN