Provider Demographics
NPI:1225107634
Name:WEISMAN, GEOFFREY (MD, PLLC)
Entity Type:Individual
Prefix:DR
First Name:GEOFFREY
Middle Name:
Last Name:WEISMAN
Suffix:
Gender:M
Credentials:MD, PLLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:233 UNION AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:HOLBROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11741-1820
Mailing Address - Country:US
Mailing Address - Phone:631-585-7771
Mailing Address - Fax:631-585-2720
Practice Address - Street 1:233 UNION AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:HOLBROOK
Practice Address - State:NY
Practice Address - Zip Code:11741-1820
Practice Address - Country:US
Practice Address - Phone:631-585-7771
Practice Address - Fax:631-585-2720
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2007-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY138665207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00694133Medicaid
NYA63662Medicare UPIN
NY00694133Medicaid