Provider Demographics
NPI:1508820622
Name:WEISMAN, ALAN (DPM)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:
Last Name:WEISMAN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:554 LARKFIELD RD STE 10C
Mailing Address - Street 2:
Mailing Address - City:EAST NORTHPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11731-4205
Mailing Address - Country:US
Mailing Address - Phone:631-368-3668
Mailing Address - Fax:631-368-3669
Practice Address - Street 1:554 LARKFIELD RD STE 10C
Practice Address - Street 2:
Practice Address - City:EAST NORTHPORT
Practice Address - State:NY
Practice Address - Zip Code:11731-4205
Practice Address - Country:US
Practice Address - Phone:631-368-3668
Practice Address - Fax:631-368-3669
Is Sole Proprietor?:No
Enumeration Date:2006-04-14
Last Update Date:2020-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC005725L213ES0103X
NYN005894213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA097776SF6Medicare ID - Type UnspecifiedMEDICARE
PAV08115Medicare UPIN