Provider Demographics
NPI:1114079746
Name:WEISS, MARK BENNETT (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:BENNETT
Last Name:WEISS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2001 MARCUS AVE
Mailing Address - Street 2:SUITE W84
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11042-1011
Mailing Address - Country:US
Mailing Address - Phone:516-775-3937
Mailing Address - Fax:516-775-2808
Practice Address - Street 1:2001 MARCUS AVE
Practice Address - Street 2:SUITE W84
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11042-1011
Practice Address - Country:US
Practice Address - Phone:516-775-3937
Practice Address - Fax:516-775-2808
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY146915207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYCO7411Medicare UPIN
NY26D211Medicare ID - Type Unspecified