Provider Demographics
NPI:1164586442
Name:WEISS, HERMAN (MD)
Entity Type:Individual
Prefix:DR
First Name:HERMAN
Middle Name:
Last Name:WEISS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:331 MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:WEST HEMPSTEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11552-3252
Mailing Address - Country:US
Mailing Address - Phone:516-505-0444
Mailing Address - Fax:516-485-9589
Practice Address - Street 1:980 N BROADWAY
Practice Address - Street 2:
Practice Address - City:MASSAPEQUA
Practice Address - State:NY
Practice Address - Zip Code:11758-2355
Practice Address - Country:US
Practice Address - Phone:516-795-2890
Practice Address - Fax:516-795-7450
Is Sole Proprietor?:No
Enumeration Date:2006-12-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY215938207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02243630Medicaid
NYH52727Medicare UPIN
NY5P4511Medicare ID - Type Unspecified