Provider Demographics
NPI:1568568459
Name:WEISS, RICHARD S (DO)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:S
Last Name:WEISS
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:5700 LAKE WORTH RD
Mailing Address - Street 2:STE 204
Mailing Address - City:GREENACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33463-4727
Mailing Address - Country:US
Mailing Address - Phone:561-966-7703
Mailing Address - Fax:561-649-7024
Practice Address - Street 1:3918 VIA POINCIANA
Practice Address - Street 2:STE 8
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33467-2991
Practice Address - Country:US
Practice Address - Phone:561-996-4370
Practice Address - Fax:561-641-2484
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2016-06-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NJMB041575207Q00000X
PAOS004765L207Q00000X
FLOS13555207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1739301Medicaid
D19744Medicare UPIN
NJ440348ASDMedicare PIN