Provider Demographics
NPI:1487012902
Name:ADAM WEISS DDS PC
Entity Type:Organization
Organization Name:ADAM WEISS DDS PC
Other - Org Name:AMSTERDAM ORAL SURGERY & DENTAL IMPLANT CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:
Authorized Official - Last Name:WEISS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:518-514-3983
Mailing Address - Street 1:1809 POTTER RD
Mailing Address - Street 2:
Mailing Address - City:AMSTERDAM
Mailing Address - State:NY
Mailing Address - Zip Code:12010-8522
Mailing Address - Country:US
Mailing Address - Phone:631-312-1806
Mailing Address - Fax:518-203-5108
Practice Address - Street 1:37 PROSPECT ST
Practice Address - Street 2:
Practice Address - City:AMSTERDAM
Practice Address - State:NY
Practice Address - Zip Code:12010-3614
Practice Address - Country:US
Practice Address - Phone:518-514-3983
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-29
Last Update Date:2016-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY544961223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03886757Medicaid
NY03569835Medicaid