Provider Demographics
NPI:1548224553
Name:WEIR, GERALD (LAC)
Entity Type:Individual
Prefix:MR
First Name:GERALD
Middle Name:
Last Name:WEIR
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:67 BURTON AVE
Mailing Address - Street 2:
Mailing Address - City:WOODMERE
Mailing Address - State:NY
Mailing Address - Zip Code:11598-1749
Mailing Address - Country:US
Mailing Address - Phone:516-295-2210
Mailing Address - Fax:516-295-9105
Practice Address - Street 1:1247 SUFFOLK AVE
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:NY
Practice Address - Zip Code:11717-4518
Practice Address - Country:US
Practice Address - Phone:631-434-7544
Practice Address - Fax:516-295-9105
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001178171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist