Provider Demographics
NPI:1104848373
Name:WEISS, IRENE (MD)
Entity Type:Individual
Prefix:
First Name:IRENE
Middle Name:
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 1:95 GRASSLANDS RD-NYMC
Mailing Address - Street 2:DEPT OF MEDICINE-MUNGER PAVILION
Mailing Address - City:VALHALLA
Mailing Address - State:NY
Mailing Address - Zip Code:10595
Mailing Address - Country:US
Mailing Address - Phone:914-594-4429
Mailing Address - Fax:914-594-4434
Practice Address - Street 1:95 GRASSLANDS RD-NYMC
Practice Address - Street 2:DEPT OF MEDICINE-MUNGER PAVILION
Practice Address - City:VALHALLA
Practice Address - State:NY
Practice Address - Zip Code:10595
Practice Address - Country:US
Practice Address - Phone:914-594-4429
Practice Address - Fax:914-594-4434
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2008-02-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY137779207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00000077222OtherGHI HMO
137779OtherCONNECTICARE
NY01009434Medicaid
NY5187547OtherAETNA PPO
NY5C6302OtherHEALTHNET
NY2399863OtherGHI PPO
NY2853647OtherAETNA HMO
NY3X1691OtherBCBS OF NY
NY137779OtherHIP
P2577693OtherOXFORD
NY793051OtherMVP
WI7779OtherATLANTIS